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Diagram of dorsal muscles —4th layer. Adapted from a diagram in 
Cunningham's Anatomy. 



PRINCIPLES OE OSTEOPATHY 



BY 



V 
DAIN L. TASKER, D.O , D.Sc.O. 



Professor of Theory and Practice of Osteopathy and Clinical 

Osteopathy in the Pacific School 

of Osteopathy. 

Fellow of the Southern California Academy of Sciences. 

President of the California State Board of Osteopathic 

Examiners. 

Vice-President of the Pacific School of Osteopathy. 

Director of the South Pasadena Osteopathic Sanatorium. 

Member of the American Osteopathic Association. 

Associate Editor of the Journal of the American Osteopathic 

Association. 

Editor of The Osteopath. 



ILLUSTRATED. 



PUBLISHED BY 

BACMGARDT PUBLISHING CO. 

LOS ANGELES, CAL. 

1903 



the library of 1 
congress, 1 


Two Copies Received | 


APR 20 "903 


Copy ught Entry 

clIass Oiy XXc No. 
COPY B.I 









Ac\ 



COPYRIGHTED 1903, BY THE AUTHOR, 

Dain L,. Tasker, D.O. 

LOS ANGELES, CALIFORNIA. 



PREFACE. 

This book on the Principles of Osteopathy is intended as 
a manual for the use of students and practitioners. There has 
been no effort on the part of the author to do more than give 
a short, terse exposition of the essential facts underlying os- 
teopathy. Realizing fully the great effort required to keep 
pace with the rapid progress of medicine in general we have 
tried to include in our chapters only that which will be solid 
food for our readers. We have long since learned that the 
hurried student and busy practitioner have no time to read 
long dessertations on any subject. Time is an essential factor 
in covering the necessary studies of an osteopathic curriculum. 

In order that the student may read these chapters intelli- 
gently he must have concluded at least ten months of study 
of Biology, Histology, Anatomy and Physiology. These sub- 
jects form the basis of the science of osteopathy. 

The author has kept in touch with the growth of osteo- 
pathy from year to year, through careful perusal of its pub- 
lished books and periodicals. 

The contents of this book are the condensed results of the 
author's study of recognized medical text books on Anatomy, 
Physiology, Histology, Pathology, Bacteriology and Diagnosis, 
of the works of the founder of Osteopathy, Dr. A. T. Still, 
Hazzard, Riggs, Henry and McConnell, of six years' expe- 
rience in the clinics of the Pacific School of Osteopathy, and the 
Infirmary in connection with this college, and six years of 
continuous teaching, two of which were devoted to Anatomy 
and Physiology and the remaining four to Theory and Prac- 
tice of Osteopathy and Physical Diagnosis. 

To enumerate the books from whose pages facts have been 
gleaned for corroborative testimony concerning the Principles 
of Osteopathy is impossible. Books have been read and laved 



8 PREFACE. 

aside and what is here written may be the result of something 
which caught the author's attention for a moment only and then 
became a maverick. 

The illustrations to elucidate the text have been furnished 
principally by the laboratories and clinics of the Pacific School 
of Osteopathy. Without the hearty and efficient aid of my as- 
sociates on the faculty of this college much of the concise detail 
of this book would have been impossible. I am indebted to 
several osteopathic physicians for drawings of histological tis- 
sues which they had prepared during their college work. They 
are given credit under their drawings. 

The large number of excellent photographs of microscopic 
structures, patients and movements is the result of the skill 
of J. O. Hunt, D. O. A few of the photographs were made by 
M. E. Sperry, D. O., who also took great care to see that we 
had the best of photographic lenses with which to work. I 
am also greatly indebted to C. H. Phinney, D. O., and J. E. 
Stuart, D. O., for their accurate demonstration of osteopathic 
movements. 

My thanks are extended to Miss Louisa Burns, B. S., for 
reading the manuscript and suggesting corrections therein, 
also to Miss Gertrude Smith for preparing the manuscript for 
the publisher. 

Dain L. Taskkr, D. O., D. Sc. O. 



TABLE OF CONTENTS. 



CHAP. I. — The Cause of Disease. — Potential and Kinetic En- 
ergy — A Normal Stimulus — A Change in Resist- 
ance — Resistance — Cause and Effect — Cell Rela- 
tions — Excessive Stimulation — Structural Defects — 
Cell Life Dependent on Circulation — Osteopathic 
Therapeutics — Incidents in the History of a Disease 
Process — Fatigue and Excess — Methods of Cure — 
Subluxations are Mechanical and Chemical Stimuli. 

CHAP. II. — Structural and Contractile Tissues. — The Cell — 
Structural Tissues — Contractile and Elastic Tissues — 
Metabolic Tissues — Irritable Tissues — Circulatory 
Tissues — 'Mechanical Principles — Displacement by 
Violence, Passive — Obstruction to Vital Forces — Pri- 
mary and Secondary Lesions — Displacement by Mus- 
cular Contraction, Active — Summary — Contractile 
Tissue — Amoeboid Motion, Contraction — Stimuli — 
Direct and Indirect Stimulation — Structural Tissues 
Affected by Contraction — Circulation of Blood in 
Muscle — Effect of Contraction, Intrinsic — Extrin- 
sic — Summary. 

CHAP. III. — Irritable Tissue. — Nerve Tissue — Irritability — 
Conductivity — Trophicity — Unity of the Nervous 
System — Mechanical Irritation — Double Conduc- 
tion—Nerve Bundles — Central Nervous System — 
Segmentation — Reflex Action — Practical Applica- 
tion — Efferent Nerves — Sympathetic Ganglia — Diag- 
nosis — Objective Symptoms — Co-ordination of Sen- 
sations — Example. 



io TABLE OF CONTENTS. 

CHAP. IV. — Circulatory Tissue. — Functions — Lymph — Blood 
— Blood Corpuscles, Red — White — Chemical Constitu- 
ents — Distribution of the Blood — Circulatory Appara- 
tus — The Heart — Regulation of Contraction — Co-ordi- 
nating Centers — The Pneumogastric Nerve-Accelera- 
tor Center — Stimulation of the Heart — Inhibition of 
the Heart — Vaso-Motor Control of the Coronary Art- 
eries — Angina Pectoris — Action of the Heart Centers, 
The Depressor Nerve — Vaso-motor Nerves — Vaso- 
constriction — Vaso-dilation — Summary — The Sensory 
Nerves — Recapitulation — Vaso-motor Centers — Con- 
clusions — Pathology — Therapeutics — Case Illustra- 
tions. 

CHAP. V. — Secretory Tissue. — Metabolism — Arrangement of 
Gland Cells — Epithelium — Protective Epithelium — Se- 
cretory Epithelium — Sensory Epithelium — Gland For- 
mation — Sexual Cells — Summary — Filtration, Osmo- 
sis and Diffusion — The Individual Cell — Secretory 
Nerve Fibers — The New Viewpoint — Necessary Con- 
ditions for Secretion — Classes of Drugs which Affect 
Secretion — Unimpeded Blood Supply — Proper Food — 
Innervation — Osteopathic Pathology — -Therapeutics — 
Direct Manipulation — Hyperaemia of the Governing 
Center — Effect on Heart Beat — Classes of Stimuli — 
Perspiration — Importance of the Cell. 

CHAP. VI. — The Sympathetic Nervous System. — Unity of 
the Nervous System — Origin — Lateral Ganglia — Four 
Prevertebral Plexuses — Visceral Ganglia — Communi- 
cating Fibers — White Rami-communicantes — Distri- 
bution — Function — Gary rami-communicantes — Dis- 
tribution — Functions of the Sympathetic System 
— Independent or Dependent — Ganglia — Cervical 
Ganglia of Importance to Osteopaths — Superior Cervi- 
cal Ganglion — Connections — Vaso-constriction — Dis- 
tribution — Headache — Middle Cervical Ganglion — 
Distribution — Function — Manipulation — Recapitu- 



TABLE OF CONTENTS. n 

lation — The Thoracic Ganglia — Rami-efferentes — Up- 
per Five Thoracic Ganglia — Nerve Distribution — The 
Interscapular Region — A Case Illustrating the Cilio- 
spinal Center — Effects of Treatment, First to Seventh 
Dorsal — Great Splanchnic — Lesser Splanchnic — Least 
Splanchnic — Functions — Theory — Lumbar Ganglia — 
Sacral Ganglia — Distribution — Function — Cardiac 

Plexus — Position and Formation — Pulmonary Plexus 
— Physiology — Functions — Treatment — Results 
— Argument — Solar Plexus — Location and Formation 
— Distribution — Function — Centers — Hypogastric 
Plexus — Location and Formation — Pelvic Plexus — 
Distribution — Subsidiary Plexuses — Function — Sum- 
mary — Automatic Visceral Ganglia — Conclusion. 

CHAP. VII.— Hilton's Law.— The Law Stated— Methods of 
Studying Anatomy — Example of Hilton's Law — The 
Knee — Object of such a Distribution — Uniformity of 
the Law — Precision of Nerve Distribution to Muscles 
— Indications for the Use of Therapeutics — The Use 
of Hilton's Law in Physical Diagnosis— Comparison 
of Methods — Herpes Zoster — The Distribution of an 
Intercostal Nerve — Some of the Evil Effects of Rest — 
Head's Law — Application of the Law — The Viscera — 
Nerves of Conscious Sensation. 

CHAP. VIII. — Subluxations. — Definition — Diagnosis — Prima- 
ry or Secondary Lesions — Analysis — Occipito-atlantal 
Articulation — The Causes of Subluxation— The Atlas 
and Axis — Unequal Development — Caries — Spontane- 
ous Reduction — Cervical Vertebrae — Dorsal Vertebrae 
— False Lesions — Lateral Subluxations — Muscular 
Contraction — Compensation of Effects of Muscular 
Contraction — Separation of Spinous Processes — Ap- 
proximation of Spinous Processes — Subluxations, Pri- 
mary — Subluxations, Secondary — Limited Area for 
Lateral Subluxations — Characteristics of the 8th to the 
1 2th Dorsal Vertebrae — Dorso-Lumbar Articulation — 
Kyphosis, Lower Dorsal — The Lumbar Region — Ex- 



12 TABLE OF CONTENTS. 

animation of the Ribs — Costo-central Articulation — 
Costotransverse Articulation — Co-ordination — Inco- 
ordination — Nervous Control of Respiration — Costal 
Subluxations — First Rib — Tenth Rib — Eleventh and 
Twelfth Ribs — Effect of Position of Vertebrae on the 
Position of Ribs — Clavicles — Sacro-iliac Articulation 
— The Nerves Affected — Symptoms — Sacro-vertebral 
Articulation — Summary. 

CHAP. IX. — Osteopathic Centers. — Diagnosis — First Four 
Cervical Nerves — Example of Hilton's Law — The 
Pneumogastric Nerve — The Hypoglossal Nerve — 
Superior Cervical Ganglion — Sub-occipital Triangles 
— Cervical Plexus — Intensity of Reflexes — The 
Spinal Accessory — The Phrenic Xerve, Hiccoughs 
— The Trapezius and Splenitis Capitis et Colli 
Muscles — Vasomotion, Head, Face and Neck — 
Affections of the Cervical Nerves — Brachial Plexus 
Affections of the Brachial X T erves — A Case of Hemi- 
paresis below the Fifth Cervical Vertebra — Subluxa- 
tion of the Scapula — The X T erve of Wrisberg — The 
Interscapular Region — The Lung Center — Cilio-spinal 
Center — Heart Center — Stomach Center — Liver and 
Spleen Center — Leukemia — Large Intestine — Small In- 
testine — Center for Chills — The Language of Pain — 
Osteopathic Mew of Pathology — Center for the Gall- 
bladder — A Case Report — Intestines — Uterus — Ova- 
ries and Testes — Kidney — Second Lumbar — Paraple- 
gia — Lumbar and Sacral Plexuses — The Bladder — 
Sphincter Vaginae — Conclusions. 

CHAP. X. — Germ Theory of Disease. — Specific Causes — Con- 
ditions which Affect Life — Resistance — Immunity — 
Specific Treatment — Summary. 

CHAP. XI. — Compensation and Accommodation. — Definition 
— The Spinal Column — Compensatory Curvature — The 
Extremities — The Thorax — Skin and Kidneys — The 
Heart — Power of Encysting. 



TABLE OF CONTENTS. 13 

CHAP. XII. — Inhibition. — Acceleration — Inhibition — Mus- 
cular Contraction — Secretion — Acceleration and Inhi- 
bition as Attributes of Nerve Tissue — Is the Work 
Done Proportionate to the Strength of Stimuli — Inhibi- 
tion a Normal Attribute of the Central Nervous Sys- 
tem — Physiological Activity is a Result of Stimulation 
— Hilton's Law — Inhibition — Therapeutics — How 
Vasomotor Centers Act — Over-stimulation equals In- 
hibition — The Guide for the Use of Inhibition — Patho- 
logical Changes which Accompany Over-stimulation — 
Rational Treatment — Hyperaesthesia of Sensory 
Areas, Diagnostic — Results of Inhibition — The Phrase 
"Remove Lesions" — The Human Body is a Vital Mech- 
anism — Structure vs. Function — Osteopathic Meaning 
of Inhibition — The Scientific Use of Inhibition — Inhi- 
bition as a Local Anaesthetic — Inhibition May Act 
without Removing a Lesion — Inhibition to Remove 
Lesions — Passive Movements vs. Rest — Inhibition as 
a Preparatory Treatment. 

CHAP. XIII. — Positions for Examination. — Testing Align- 
ment and Flexibility — Sense of Touch — Inspection — 
Palpation of the Ribs — Palpation of the Spine — Ex- 
trinsic and Intrinsic Muscles of the Back — The Diag- 
nostic Value of Hyperaesthesia — Testing Muscular 
Tension — Thoracic Flexibility — Examination of the 
Abdomen — Elevation or Depression of Ribs — Examin- 
ation of the Rectum and Prostate Gland — Examination 
of the Neck — The History of Lesions — The Extremi- 
ties — Subjective Symptoms. 

CHAP. XIV.— Manipulation. — Method of Procedure— Relax- 
ation of the Latissimus Dorsi — Relaxation of the Tra- 
pezius — Relaxation of the Rhomboids — The Pectoralis 
Major and Serratus Magnus — Quadratus Lumborum 
— The Erector Spinae — Treatment of Simple Kypho- 
sis — Lordosis — Upper Dorsal — The Variety of Move- 
ments which will secure the Same Results — The Head 



14 TABLE OF CONTENTS 

and Neck as a Lever — Lordosis or Kyphosis may Affect 
a Function Similarly — Splenitis Capitis et Colli — Ky- 
phosis, Upper Dorsal — Kyphosis, Dorso-lumbar — 
Contra-indications — Other Movements — Dorsal Rota- 
tion — Know how to Apply Principles — Do not Copy 
Movements. 

CHAP. XV. — Reduction of Subluxations. — Lateral Subluxa- 
tion — Lower Dorsal — A Depressed Spine — Kyphosis, 
Pott's Disease — Rib Subluxations. 

CHAP. XVI. — Treatment of the Cervical Region, — To Raise 
the Clavicle — Subluxation of the Clavicle — Prepara- 
tory Treatment of the Neck, Trapezius — Sterno-cleido- 
mastoid — Scaleni — Splenius Capitis — Extension — Ro- 
tation — The Hyoid Bone — Mylo-hyoid and Hyoglossus 
— Sterno-thyroid and Sterno-hyoid — Intrinsic Muscles 
of the Larynx — The Atlas — Sixth Cervical. 

CHAP. XVII. — Treatment of the Extremities. — Diagnosis 
— Causes of Stiff Joints, Ankylosis — The Scapulo-hu- 
meral Articulation — Examination of the Brachial 
Plexus — Reduction of Dislocation by Traction — By 
Leverage — Elbow Articulation — The Radius — Old 
Dislocations — Muscles of the Lower Extremities — 
Quadriceps Extensor — The Adductor Group — Disloca- 
tion of the Femur — Stretching the Sciatic — The Calf 
Muscles — Scientific Manipulation — Saphenous Open- 
ing — Popliteal Space. 

CHAP. XVIII.— Manipulation for Vaso-Motor Effects.— The 
Fifth Cranial Nerve — Inhibition of the Sub-occipital. 



INTRODUCTION. 



Great strides have been made during the past twenty-five 
years in the practice of medicine. The relative positions for- 
merly held by drug therapy and surgery have been completely 
reversed. The concoctions of the pharmocopceia, with their 
vague and uncertain effects upon human tissues and functions, 
no longer entice the earnest seeker after medical truths to spend 
a lifetime experimenting with substances which are absolutely 
foreign to the human body. 

There was a time, not far away, when that person who 
treated human diseases by manipulation, water, diet and gen- 
eral hygiene was considered to be the chief of impostors. Go 
a little farther back in the history of medicine and we see sur- 
gery dishonored because it was mechanical, not mystical 
enough for the ponderous minds whose fort it was to deal with 
strange substances of the animal, vegetable and mineral king- 
doms. 

During all the years in which drug-therapy flourished 
there were a few real scientists who devoted time and talents 
to the structure of our bodies and the function of each part. 
Discoveries came slowly along these lines because the majority 
of medical men were concentrating their energies on ferreting 
out the effects of drugs. Facts in anatomy and physiology 
which are so patent to us at this time, remained obscure for 
centuries simply because there was no thought of studying the 
form and action of tissues, while all nature outside of our own 
bodies seemed to be a grand laboratory of specifics for human 
ailments. 

If osteopathy had been born fifty years ago, it would have 
died because the popular and scientific minds were not in a 
condition to receive it. Even the time at which it was born. 



i8 INTRODUCTION. 

scarcely twenty-five years ago, was hardly ripe for this new 
departure in medicine. Eight years easily cover the period 
of its active history. 

A Scientific Growth. — There is one distinctive point 
about osteopathy which should be especially emphasized: It 
is not an empirical system ; nothing is done on the cut and try 
plan. It has been developed in a purely scientific way. We 
might observe the action of the human body in health and 
disease indefinitely without securing any exact data to pass on 
to the next generation of observers if we fail to know the struc- 
ture of the body. A physician may learn many things in an 
empirical way w T hich are very poor assets for science. 

The strange part of medical history, to the modern inves- 
tigator, is the fact that discoveries in anatomy and physiology, 
which are of such vital importance to the successful treatment 
of human diseases, were left stored away between the covers 
of books, not deemed of any value except to whet the mind of 
the dilletante in medicine. 

Osteopathy as a distinct system of medicine has grown 
to its present proportions at a time when the older schools 
of medicine are making radical changes in their therapeutical 
procedures, e. g., serum-therapy. In spite of all these so- 
called scientific advances in drug-therapy, osteopathy has made 
steady advance into public favor, thereby showing that it is 
fully able to compete with the older systems of practice. 

The Founder of Osteopathy.— Dr. A. T. Still, of Kirks- 
ville, Mo., is the honored founder of this system of therapeu- 
tics. His early w T ork was of that persistent, plodding char- 
acter which is necessary in order to build a firm foundation 
for accurate observation in later years. He did not sit and lis- 
ten to flowing sentences from the mouths of lecturers, and 
straightway assert that certain things are causes of disease. 
His work was in studying the structure of our bodies directly, 
and thus gain an accurate knowledge of how bones, ligaments 
and muscles, blood-vessels, glands and nerves are placed. 
Then he sought that department of knowledge which we call 
physiology, and learned how these tissues act in health. Hav- 
ing had previous training in treating diseases by the drug meth- 



INTRODUCTION. 19 

od, he was slow to discard the old method for one which had 
never been tried, even though it had good scientific reasons 
back of it. But the substitution did take place by degrees 
until his system of therapeutics no longer made use of drugs. 

It seems to be a popular idea that it is necessary for the 
founder of a system to have a creed or statement of belief. 
We do not doubt but that it is good for us at times to try to put 
our beliefs in writing, not to form a fixed position, but just as 
the architect draws many plans to gradually develop his mental 
pictures. These statements usually contain the truth about 
our work so far as we know it. We can thus see how far we 
have advanced and realize that we have much to learn. 

Dr. Still has, from time to time, expressed the result of 
his studies, that is, the observed facts upon which he has 
built his system of therapeutics. In 1874, Dr. Still stated his 
observations as follows : "A disturbed artery marks the period 
to an hour, and minute, when disease begins to sow its seeds 
of destruction in the human body. That in no case could it 
be done without a broken or suspended current of arterial 
blood which, by nature, is intended to supply and nourish all 
nerves, ligaments, muscles, skin, bones and the artery itself. 
* * *The rule of the artery must be absolute, universal, and 
unobstructed, or disease will be the result. * * * All 
nerves depend wholly upon the arterial system for their 
qualities, such as sensation, nutrition and motion, even though 
by the law of reciprocity they furnish force, nutrition, and 
sensation to the artery itself." 

Definitions. — Many definitions have been formulated 
and published to the world. Each one tends to limit one's con- 
ception of osteopathy in some particular. A definition always 
limits the thing defined, therefore, no definition of osteopathy 
can be complete, because we are dealing with a principle, the 
universality of which no one knows. Whereas, less than seven 
years ago, it was thought that osteopathy was an excellent 
method of treating chronic ailments, we now find osteopaths 
working day and night at the bedside of the acutely sick. Thus 
does it spread and become thoroughly recognized as a svstem 
applicable to all diseases. 



2o INTRODUCTION. 

In order to bring before the student as full and compre- 
hensive an idea of the scope of osteopathy as possible, a series 
of definitions are quoted. These definitions have been taken 
from current osteopathic literature and are credited to their re- 
spective authors. 

One of the short paragraphs in Dr. Still's autobiography 
is sufficient to give a clear understanding of his idea of the 
human body. ''The human body is a machine run by the un- 
seen force called life, and that it may be run harmoniously, it 
is necessary that there be liberty of blood, nerves and arteries 
from the generating point to destination." 

The following definition is one which has been used in 
the American School publications for a long time: "Osteo- 
pathy is that science which consists of such exact, exhaustive 
and verifiable knowledge of the structures and functions of the 
human mechanism, anatomical, physiological and psychologi- 
cal, including the chemistry and physics of its known elements 
as has made discoverable certain organic laws and remedial 
resources, within the body itself, by which nature, under the 
scientific treatment peculiar to osteopathic practice, apart from 
all ordinary methods of extraneous, artificial, or medicinal 
stimulation, and in harmonious accord with its own mechanical 
principles, molecular activities, and metabolic processes, may 
recover from displacements, disorganizations, derangements, 
and consequent disease, and regain its normal equilibrium of 
form and function in health and strength." Mason W. 
Pressly, A. B., Ph. D., D. O. 

"Osteopathy is that science of healing which emphasizes, 
(a) the diagnosis of disease by physical methods with a view 
to discovering not the symptoms but the causes of diseases, in 
connection with misplacements of tissue, obstruction of the 
fluids and interference with the forces of the organism; (b) 
the treatment of diseases by scientific manipulations in con- 
nection with which the operating physician mechanically uses 
and applies the inherent resources of the organism to overcome 
disease and establish health, either by removing or correcting 
mechanical disorders, and thus permitting nature to recuperate 
the diseased part, or by producing and establishing antitoxic 



INTRODUCTION. 21 

and antiseptic conditions to counteract toxic and septic con- 
ditions of the organism or its parts; (c) the application of me- 
chanical and operative surgery in setting fractured or dislo- 
cated bones, repairing lacerations and removing abnormal tis- 
sue growths or tissue elements when these become dangerous 
to the organic life." J. Martin Uttlejohn, IX. D., M. D., D. O. 

''Osteopathy is a school of mechanical therapeutics based 
on several theories. 1. Anatomical order of the bones and 
other structures of the body, is productive of physiological 
order, i. e., ease or health in contradistinction to disease or dis- 
order which is usually due, directly, or indirectly, to anatomical 
disorder. 2. Sluggish organs may be stimulated mechanically 
by way of appropriate nerves (frequently by utilizing re- 
flexes) or nerve centers. 3. Inhibition of over-active organs 
may be effected by steady pressure substituted for the mechan- 
ical stimulation mentioned above. 4. Removal of causes of 
faulty action of any part or organ is the keynote of the 
science." C. M. Case, M. D., D. O. 

Thus the word (osteopathy) has 

come to mean that science which finds in disturbed mechan- 
ical relations of the anatomical parts of the body the causes 
of the various diseases to which the human system is liable; 
that science which cures disease by applying technical knowl- 
edge and high manual skill to the restoration of any or all dis- 
turbed mechanical relations occurring in the body." Chas. 
Hazzard, Ph. B., D. O. 

"Osteopathy means that science or system of healing 
which treats diseases of the human body by manual thera- 
peutics for the stimulation of the remedial and resisting forces 
within the body itself, for the correction of misplaced tissue 
and the removal of obstructions or interferences with the 
fluids of the body, all without the internal administration of 
drugs or medicines." Chas. C. Teall, D. O., President of the 
American Osteopathic Association. 

"Osteopathy is that school of medicine whose distinctive 
method consists in (1) a physical examination to determine 
the condition of the mechanism and functions of all parts of 
the human body, and (2) a specific manipulation to restore the 



22 INTRODUCTION. 

normal mechanism and re-establish the normal functions. 
This definition lays stress (i) upon correct diagnosis. The 
osteopath must know the normal and recognize any departure 
from it as a possible factor in disease. There is not one fact 
known to the anatomist or physiologist that may not be of 
vital importance to the scientific osteopath. Hence a correct 
diagnosis based upon such knowledge is half the battle. With- 
out it scientific osteopathy is impossible and the practice is 
necessarily haphazard or merely routine movements. The 
definition lays stress upon (2) removal of the cause of disease. 
A deranged mechanism must be corrected by mechanical 
means specifically applied as the most natural and only direct 
method of procedure. This work is not done by any of the 
methods of other schools. After the mechanism has been cor- 
rected little remains to be done to restore function; but stimu- 
lation or inhibition of certain nerve centers may give tempo- 
rary relief and aid nature. The adjuvants used by other 
schools, such as water, diet, exercise, surgery, etc., are the 
common heritage of our profession and should be resorted to 
by the osteopath if they are indicated." E. R. Booth, Ph. D., 
D. O., Ex-President A. O. A. 

"1. Osteopathy is a physical method of treating disease 
without drugs. 

2. Osteopathy is applied physiology. 

These two definitions refer to osteopathy in its broad 
sense. 

3. The cell is the unit of the body which inherits its 
vitality. This vitality is kept up by pabulum received from 
the blood, while the waste is carried away by the lymph and 
venous streams. . 

The differentiated cell to be able to trophize properly 
must receive a nerve. Every cell has the inherent capacity 
to recuperate after injury, and as the nervous system controls 
the circulation of the blood, it follows that any abnormality 
of position or size of any tissue or any change in the chemical 
constitution of a tissue leads to disease. 

The nervous system yields most readily to mechanical 
stimuli, therefore "osteopathy is the art of treating disease by 



INTRODUCTION. 23 

physical and mechanical means ; the science of aiding the vital 
processes by means of stimulation or inhibition of nerves, 
and by the removal of lesions or "obstructions." J. W. Hof- 
sess, D. O. 

"Osteopathy is a complete system of healing, wherein 
only food and water is allowed to enter the stomach, and all 
natural means are employed to place a diseased body under 
such conditions as will permit nature to effect a cure, includ- 
ing the most effective dietetic and hygienic measures, such as 
suggestion, fasting, exercise and hydrotherapy ; special use 
being made of manipulations that normalize the tonicity of 
muscles, the flow of blood and lymph, the transmission of nerve 
force and the functioning of bodily organs by replacing de- 
ranged anatomical structures, stretching and pressing mus- 
cles, vessels and nerves, freeing the movements of joints 
and correcting dislocations and subluxations." C. W. Young, 
D. O. 

"Osteopathy is that science or system of healing which, 
using every means of diagnosis, with a view to discovering, 
not only the symptoms, but the causes of disease, seeks, by 
scientific manipulations of the human body, and other physical 
means, the correcting and removing of all abnormalities in 
the physical relations of the cells, tissues and organs of the 
body, particularly the correcting of misplacements of organs 
or parts, the relaxing of contracted tissues, the removing of 
obstructions to the movements of fluids, the removing of 
interferences with the transmission of nerve impulses, the 
neutralizing and removing of septic or foreign substances 
from the body; thereby restoring normal physiological pro- 
cesses, through the re-establishment of normal chemical and 
vital relations of the cells, tissues and organs of the body, and 
resulting in restoration of health, through the automatic stim- 
ulation and free operation of the inherent resistant and 
remedial forces within the body itself." C. M. Turner Hulett, 
D. O. 

"Osteopathy is that science which reasons on the human 
system from a mechanical as well as a chemical standpoint, 
taking into consideration in its diagnosis, heredity, the habits 



24 INTRODUCTION. 

of the patient, past and present ; the history of the trouble, in- 
cluding symptoms, falls, strains, injuries, toxic and septic 
conditions, and especially in every case a physical examination 
by inspection, palpation, percussion, auscultation, etc., to de- 
termine all abnormal physical conditions ; the treatment em- 
phasizing scientific manipulation to correct mechanical lesions, 
to stimulate or inhibit and regulate nerve force and circula- 
tory fluids for the recuperation of any diseased part, using 
the vital forces within the body ; also the habits of the patient 
are regulated as to hygiene, air, food, water, rest, exercises, 
climate and baths, such means as hydropathy, electricity, mas- 
sage, antidotes and antiseptics, and suggestion sometimes being 
used as adjuncts." Chas. C. Reid, D. O. 

"Osteopathy is a method of treating disease by manipu- 
lation, the purpose and result of which is to restore the normal 
condition of nerve control and blood supply to every organ 
of the body by removing physical obstruction, or by stimu- 
lating or inhibiting functional activity as the condition may 
require." Wilfred L. Riggs, D. O. 

"Osteopathy is a system of medicine, characterized- by 
close adherence to the physiological axiom that perfect health 
depends on a perfect circulation, and perfect nerve control in 
every tissue of the body. Its etiology emphasizes physical 
perversions of tissue relations as causes of disease. Its diag- 
nosis is mainly dependent on the discovery of physical lesions 
by means of palpation. Its therapeutics comprehends (i) 
manipulation, including surgery, for purposes of readjusting 
tissue relations; (2) scientific dietetics; (3) personal and pub- 
lic hygiene/' Dain L. Tasker, D. O. 

The above definitions have nearly all been taken from 
the Journal of the American Osteopathic Association. 

Osteopathic Diagnosis. — Physical diagnosis is and al- 
ways will be the leading factor in the success of osteopathic 
practitioners. This ability to take hold of an ailing human 
being and detect the disturbing factor in it, is the highest at- 
tainment of the physician. Osteopathy has developed the art of 
palpation to a wonderful degree. Basing this art on a definite 
knowledge of structure and function makes it the chief reliance 



INTRODUCTION. 25 

in diagnosis. Every physical diagnosis begins with palpa- 
tion and proceeds with auscultation and percussion, and not 
failing to use chemical and microscopical methods when 
necessary. The student must learn to use his sense of touch 
continually, in fact, learn to see with his fingers. Add to this 
development of touch a training in chemical and microscopical 
analysis of secretions and excretions of the body, and we have 
a practitioner thoroughly equipped to make an accurate scien- 
tific diagnosis. 

Osteopathic Therapeutics. — Osteopathic treatment is 
based on this kind of physical diagnosis which we have just 
described. It takes into account the fact that the organism is 
a self-recuperating mechanism and requires proper food, 
proper surroundings, and perfect activity of every tissue, espe- 
cially the blood. Thus we divide treatment into three di- 
visions, (1) manipulation for the purpose of correcting the 
mal-position of any tissue, whether that tissue be bone or 
blood; (2) proper feeding, i. e., dietetics; and (3) proper 
surroundings, i. e., hygiene. 

If the condition of the body is such that none of the 
three methods just mentioned will right the difficulty, i. e., if 
there are broken bones, ruptured muscles and connective tis- 
sues or false growths, we can then use surgical means. 
Surgery is a part of the osteopathic system, just as it is of all 
systems of medicine. The chief assurance lies in the fact that 
the osteopathic system is very conservative as regards the use 
of the knife. 

Osteopathy includes all those qualities which make up a 
successful system ; its diagnosis is accurate and its treatment 
is comprehensive, including scientific manipulations, scientific 
dietetics, hygiene and surgery. 

In a recent article in the American Monthly Review of 
Reviews, the following sentences appear : "With but few 
exceptions, the entire vegetable and mineral kingdoms have 
given us little of specific value; but still, up to the present 
day, the bulk of our books on materia medica is made up of a 
description of many valueless drugs and preparations. Is it 
not to be deplored that valuable time should be wasted in our 



26 INTRODUCTION. 

student days by cramming into our heads a lot of therapeutic 
ballast." 

This is probably the most recent statement of this kind in 
the public prints. It substantiates the position taken by the 
osteopathic colleges. We feel justified in claiming that os- 
teopathy today occupies a position which every other system 
of medicine must come to sooner or later. It is broad enough 
and liberal enough to accept truth wherever demonstrated. 
Its foundations being laid in the basic sciences, and its treat- 
ment never departing from the facts of these sciences, make 
it a system of lasting worth and capable of adding an entirely 
new conception of the phenomena of life to medical litera- 
ture. 

The formation of the name osteopathy (from osteon, 
bone, and pathos, suffering) seems to be as perfect a descrip- 
tive name as it is possible to form which would cover the 
basic principle of the science. The bones are the foundation 
upon which all the soft tissues are laid, and the osteopath 
makes all his examinations, using them as fixed points from 
which to explore for faulty arrangement. The name does 
not mean bone disease, but since the osteopath finds many 
diseases resulting from pressure due to slightly displaced bone, 
the name is used in the sense of disease caused by bone. We 
do not consider that all diseases are caused by displaced bone, 
but it is a cause which has heretofore been overlooked. We 
recognize that there are many causes of disease, and do not 
wish to be understood as trying to fit fact to theory, but as a 
result of observing certain facts, this basic principle of os- 
teopathy has been made clear. 

We believe that health is the natural state, and that this 
condition is bound to be maintained so long as every cell has 
an uninterrupted blood supply, and its controlling nerve is 
undisturbed. Therefore, the first effort of the osteopath is 
to remove all obstructions to blood and nerve supply, feeling 
certain that when these obstructions are removed, health will 
follow. Hilton in his lectures on "Rest and Pain," which are 
considered medical classics, has expressed himself forcibly on 
this subject, as follows: "It would be well, I think, if the 



INTRODUCTION. 27 

surgeon would fix upon his memory, as the first professional 
thought which should accompany him in the course of his 
daily occupation, this physiological truth — that nature has a 
constant tendency to repair the injuries to which her struc- 
tures may have been subjected, whether those injuries be the 
result of fatigue or exhaustion, of inflammation or accident. 
Also that this reparative power becomes at once most con- 
spicuous when the disturbing cause has been removed; thus 
presenting to the consideration of the physician and surgeon a 
constantly recurring and sound principle for his guidance in 
his professional practice." 

Every system of curing human ills, which is based on 
the known facts of anatomy and physiology will last, because 
it is true. When systems of drug medication are known only 
as history, osteopathy will be ministering to the human race, 
because it knows no other path than that which leads to 
greater truths in physiology and anatomy. 



CHAPTER 1. 



THE CAUSE OF DISEASE. 

Potential and Kinetic Energy. — The cause of disease 
is in the cells of the body. They contain the stored energy, 
i. e., potential energy. When this potential energy is released 
by some other force, or stimulus, we have kinetic energy. 
Potential energy cannot transfer itself spontaneously into 
kinetic energy without first being affected by some other force 
which may be called a stimulus. The amount of potential 
energy converted into kinetic is not proportional to the amount 
of the stimulus used to initiated the process. All stored energy, 
i. e. potential energy, requires a certain strength of stimulus 
to start the process of conversion into kinetic. When this 
strength of stimulus is known it is called the normal. There 
are usually several kinds of stimuli, each one having a vary- 
ing degree of intensity. For example, the potential energy 
in a muscle fiber will be converted into kinetic energy as a 
result of mechanical, thermal, chemical or electrical stimuli. 
Certain amounts of each of these stimuli are required to 
initiate the change in the form of energy. 

A Normal Stimulus. — The potential energy in a muscle 
fiber has a certain degree of resistance to stimuli. A definite 
amount of any one of the four forms of stimuli named is 
necessary to cause the muscle fibre to contract. This definite 
amount, which is capable of stimulating the muscle to an 
average contraction is called the normal stimulus, and the 
action of the muscle is called the normal contraction. If the 
muscle should contract more vigorously than usual in re- 



3o PRINCIPLES OF OSTEOPATHY. 

sponse to this normal stimulus, the resistance of the potential 
energy of the muscle fibre is below normal. The strength of 
stimulus and discharge of energy may vary greatly in their 
proportions within normal limits, but there are well marked 
lines above or below which resistance is spoken of as above 
or below normal. 

A Change of Resistance. — When the resistance of the 
potential energy is below normal, a normal stimulus causes 
too great an effect, that is, too much potential energy is trans- 
ferred into kinetic energy. When the resistance of the po- 
tential energy is normal, and the stimulus above normal, there 
also results an excessive discharge of potential energy. There- 
fore, excessive discharge results from lowered resistance, or 
increase of stimulus. 

Resistance. — Resistance is a quality of the cell proto- 
plasm. The stimulus is an external force. 

The cell depends on proper surroundings in order to 
maintain its resistance to external stimuli, such as bacteria. 
The strength of bacteria may also be increased or decreased 
by the nature of their surroundings. 

Cause and Effect. — After potential energy has been 
changed into kinetic energy, this latter may generate 
more potential energy, and this also may be converted into 
kinetic. Thus cause is converted into effect and effect into 
cause. This is an endless chain. When such a process is 
beyond the normal, as in the body when varying symptoms 
present themselves, therapeutic efforts must be concentrated 
on some one particular reflex in order to break the chain. 

Cell Relations. — The relation of a cell with its fellows 
that is, its structural relations, are the basis upon which its 
resistance, in large measure, depends. Therefore, anything 
which disarranges its normal relations will, in all probability, 
change its resistance to stimuli. All therapeutic methods 
which aim at lessening the too rapid conversion of potential 
into kinetic energy, that is, increasing cell resistance, must 
see that correct structure is attained. 

Excessive Stimulation. — In cases where almost com- 
plete exhaustion of potential energy has resulted from lowered 



PRINCIPLES OF OSTEOPATHY. 31 

resistance and we find that even increased strength of stimulus 
fails to evoke a response, the same structural fault may exist. 
We know that stimulation, when excessive, passes into inhi- 
bition. Perhaps it is truer to state that over activity of a 
cell leads to exhaustion of its potential energy. The stage of 
exhaustion, in this sense, is consonant with inhibition. As an 
example : In case of structural changes in the lumbar re- 
gion, there may result a change in resistance in the secretory 
and contractile cells of the intestines due to changed blood 
supply. Diarrhoea results for a time, followed by constipa- 
tion. At the beginning of the rapid conversion of potential 
into kinetic energy the muscles feel tense. After the consti- 
pation, or period of exhaustion, sets in, they are flabby. 

Structural Defects. — Structural defects may result in 
lowered resistance in groups of cells. They also act as 
stimuli to set free the potential energy in these cells. In many 
cases we note only a predisposition to yield to weak stimuli. 
This is the condition in individuals who are "fairly well," but 
cannot endure any of the normal stimuli in average amount. 
They cannot exercise freely without a bad reaction. A slightly 
heavier meal than usual ; the excitement due to the presence of 
many people arouses "symptoms." Their physiological pro- 
cesses are easily perverted by normal stimuli because a struc- 
tural defect, either directly or indirectly, has decreased cell 
resistance. Cases of lowered resistance, supposed to be due to 
heredity, should be carefully examined for structural defects. 
It is not improbable that many an ancestor is wrongly accused 
of transmitting a "predisposition." 

While cell resistance remains below normal, all external 
stimuli, such as atmospheric changes and presence of bacteria, 
even if in only normal amounts, may call forth "symptoms of 
disease." 

Cell Life Dependent on Circulation. — The individual 
cells of the body depend on the supply of nourishment brought 
to them by the circulating fluids of the body. The protoplasm of 
the cells is a complex, chemical substance made up of an enor- 
uous number of complex molecules. These molecules, on ac- 
count of the looseness of combination of their atoms, require 






32 PRINCIPLES OF OSTEOPATHY 



sufficient crude material brought to them to maintain the 
proper atomic tension. Upon this tension is based the re- 
sistance to normal or abnormal stimuli. 

The necessary food for cell protoplasm is brought to the 
cells by blood and lymph. Since cell protoplasm is entirely 
dependent upon the circulating media, any disturbance of these 
media changes the metabolism of the cell, and hence a change 
in resistance results. This resistance may be varied by failure 
on either the arterial or venous side of the general circulation, 
resulting in changed lymph circulation. The constant removal 
of katabolic products is of as much importance as the constant 
renewal of material for anabolism. 

Intracellular tension, i. e., the cohesiveness of the atoms 
of each molecule, is dependent on lymphatic circulation, this 
upon arterial and venous circulation. If there is abnormal va- 
riation in any of these circulatory fluids, there results a change 
in resistance of the cells. Therefore a normal stimulus may 
provoke too great a transference of potential into kinetic en- 
ergy and thus initiate a chain of such transferences of one 
form of energy into another. As a rule, the kinetic energy 
which results from the release of potential energy in excessive 
amounts acts as a stimulus to release still more potential 
energy and so on to the point of exhaustion of the supply of 
such stored energy. This change is exemplified in the series 
of symptoms which appear in many diseases. Each liberation 
of a new supply of energy gives rise to a new symptom. If 
the potential energy resides in a gland, excessive secretion re- 
sults ; if in muscle, excessive contraction, etc. The way in 
which the kinetic energy is manifested depends upon the 
manner in which its cause, i. e., potential energy, is stored. 
The secretion or the contraction may act as a stimulus to lib- 
erate still more potential energy. 

Osteopathic Therapeutics. — Therapeutics of osteo- 
pathic medicine is addressed : First, to correction of structure 
with consequent increase of cell resistance to stimuli ; second, 
to reducing the intensity and power of external stimuli to or 
below normal. 

"In no case can anything appear in the form of disease 



PRINCIPLES OF OSTEOPATHY. 33 

which was not previously present in the body as a predisposi- 
tion ; external forces are able merely to make this predispo- 
sition apparent. . . . When the physician, by thorough 
observation and investigation, knows the conditions that influ- 
ence a given predisposition in a definite way, when he is 
scientifically trained and has a true conception of hygiene, and 
is at once physician and naturalist, then he is able to cure 
disease by use of the very same forces which serve to create 
or alter the human constitution. In this simple sense there 
is a true art of healing." Hueppe's Principles of Bacteriology. 
Page 249. 

It is therefore necessary that anatomy should hold the 
most important position among the studies requisite for a 
thorough understanding of osteopathic therapeutics. Physi- 
ology, the normal reaction of cells to normal stimuli, is next in 
importance. The study of external stimuli may be compre- 
hended under the titles Hygiene and Bacteriology. Symptoms 
are the surface play of kinetic energy. They lead to a broad 
understanding of vital phenomena. 

Incidents in the History of a Disease Process. — Other 
schools of medicine note uric acid or bacteria as causes of dis- 
ease processes. Osteopathic etiology views these as incidents 
in the history of disease processes. The cause lies in the cells 
and their lowered resistance to normal stimuli. The condi- 
tion of lowered resistance is viewed as a result of structural 
changes which interfere with the nerve control of the indi- 
vidual cells with the lymphatic circulation upon which the 
cells depend for nourishment. These changes strike at the 
very root of tissue life and resistance, hence open the way for 
external stimuli to cause too great a discharge. 

The presence of bacteria is of little moment until cell re- 
sistance has been reduced sufficiently to allow them to grow 
and manufacture their poisonous products. 

A fall or sprain may be responsible for a slight sublux- 
ation of a rib. This subluxation affects the nutrition of the 
cells forming the lungs, resistance is lowered. Baccilli of 
tuberculosis may be present in the inspired air. They find a 
fertile spot in this area of lessened resistance. Resistance 



34 PRINCIPLES OF OSTEOPATHY. 

must be increased in this area in order to head off the disease 
process. Nature has two methods of overcoming the disease. 
First, she tries to eliminate it from the body; failing in this, 
she tries to compensate for it by throwing the burden of 
work on some other tissue, or again, to accommodate. We 
see compensation illustrated by increase of heart muscle in 
case of dilation. Accommodation is illustrated by forming a 
wall of connective tissue around a diseased area, thus prac- 
tically eliminating that area from direct physiological activity 
with the rest of the body, even though it is actually within the 
body. This last process is to all intents and purposes, equiva- 
lent to the first, i. e., elimination. 

Whether the illness be ascribed to uric acid or bacteria, 
there is something back of these which has been the cause. 
Some disturbance of the normal metabolism has resulted in 
the formation and retention of uric acid. We consider that 
some structural lesion, in the area of the spine from which the 
nerves of the gastro-intestinal tract emanate, must have dis- 
turbed the normal rythm. 

When rheumatism of an extremity exists, we do not use 
salicylates, but we examine the structures which might affect 
the innervation and circulation of the extremity. 

Fatigue — Excess. — Although structure is examined 
with the fact in mind that it may affect function, we do not 
forget the fact that function may affect structure. With this 
in view, we are interested in knowing what effects may have 
resulted from fatigue of any organ or the entire body, the ef- 
fects of excess in eating, drinking or sexual intercourse. 

We have stated that increase of normal stimuli may cause 
a lessened resistance. Thus indulgence in pleasurable sensa- 
tions, whether of eating, drinking or sexual intercourse may 
result in structural defects and lessened resistance. 

Methods of Cure. — To cure these various conditions, 
we use manipulations and surgical methods to correct struc- 
tural defects in so far as it is possible. Resistance is thus in- 
creased. External stimuli are decreased so far as possible. 
Hygienic living and antiseptics aid in decreasing external 
stimuli. Water may be sterilized to eliminate any typhoid 



PRINCIPLES OF OSTEOPATHY. 35 

bacilli, mosquitos killed to check malarial infection. These 
are recognized as methods of decreasing external stimuli. 

Subluxations Are Mechanical and Chemical Stimuli. — 
Physiological writers mention four forms of stimuli of muscle 
and nerve, mechanical, chemical, thermal and electrical. The 
will may be named as a fifth form. Osteopathic medicine rec- 
ognizes a sixth form which may be mechanical or chemical. 
It is the stimulation occasioned by the pressure of bone, 
muscle, or ligament upon nerve fibres or blood vessels. If the 
pressure is exerted directly upon a nerve bundle, the stimula- 
tion is mechanical ; if it affects the metabolism of other tissues 
as a result of obstruction to circulation, the nerve endings 
are affected by chemical stimulation. This is an etiological 
factor not reckoned with in other schools of medicine. It is a 
distinctive feature of osteopathic medicine. 

A twisted rib affords an example of this form of stimu- 
lation affecting nerve fibres in relation with it. The intercostal 
nerves supply motor fibres to the intercostal muscles, sensory 
and secretory fibres to the pleura and skin. The irritation re- 
sulting from a twisted rib pressing upon the intercostal nerve 
may result in intercostal neuralgia, pleurisy, or herpes, com- 
monly called "shingles." If the irritation is removed, that is, 
the rib brought into proper relation with its fellows, the neural- 
gia, pleurisy or herpes is cured. They are the symptoms of a 
disturbed nerve. The stimulating impulses, originated by the 
pressure, cause changes in the activity of the tissues which are 
innervated by the irritated nerve. 



36 PRINCIPLES OF OSTEOPATHY. 






CHAPTER II. 

STRUCTURAL AND CONTRACTILE TISSUES. 

The Cell. — Mechanical and vital phenomena are stud- 
ied carefully by the osteopath. In order to know these phe- 
nomena and correctly interpret them he must first study the 
structure and functions of the cell. 



1 


: .f x i <K \$ 




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A 




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-.:- fS^ 




S.mt iiVnuF, L^T»rm». 




S >< t> n. i «■ 5 Ox 3 n «,. * t 'A ~a Hr V , t« « tU f 




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r„..,,tc §.->.»<, 


-.:i p5U:.)j»:'>...| . «!»<>- ,,£.£,^?CZ«vu-r- 



Fi'g. i. — Unicellular organisms possessing all of the vegetative and vital attributes. 

The attributes of this small element of the body are both 
vegetative and vital. Its vegetative attributes are three : 
metabolism, growth and reproduction. Its vital attributes are 
irritability and motion. 



PRINCIPLES OF OSTEOPATHY 



37 



Following these natural divisions we find that the col- 
lections of cells to form tissues divide themselves into groups 
possessing definite qualities or attributes corresponding to one 
or the other of these vegetative or vital attributes of the orig- 
inal cell. 




Fig. 2.- — Photomicrograph of dividing cells. Cross section of young white fish, 
Coregonus. From slide prepared by Prof. B. M. Davis, Biologist in State 
Normal School, Los Angeles, Cal. 



As the original cell divides and redivides we find certain 
groups of cells perpetuating, modifying and intensifying some 
special attribute of the parent cell. Naturally, as osteopaths, 
and following lines of tissue development, we are interested, 
first, in following the lines of development of structural tissues. 

Structural Tissues. — Under this head we collect a con- 
siderable number of tissues whose function or special labor is 
to support the more active tissues. They give form and sta- 



33 



PRINCIPLES OF OSTEOPATHY. 



bility to the body. Bone, cartilage, ligament, tendon, fascia 
and connective tissue form this class. 




Pi&- 3- — Cross section of bone. Camera lucida drawing by A. M. Hewitt, In- 
structor in the Physiology of the Eye, Pacific School of Osteopathy. 

Contractile and Elastic Tissues. — Muscle and elastic 
ligaments constitute this class and serve to infuse action into 
the combination of structural tissues just named. 




SCrUred Muscle. 

Fig. 4. — Muscle fibers, striated. Camera lucida drawing by J. E. Stuart, D. O. 

Muscle unites two attributes of the original cell, i. e., it is 
a vegetative structural tissue and a vital motor tissue. This 
combination of attributes brings about many strange phe- 
nomena, as we shall see later. 




Pig- 5- — Yellow elastic tissue. Camera lucida drawing by A. M. Hewitt. 



PRINCIPLES OF OSTEOPATHY. 



39 



Yellow elastic tissue as we find it in the ligamentum 
nuchae and the ligamenta subflava must be considered as some- 
thing more than structural tissue, hence we place it in this 
class. 

Metabolic Tissues. — No sharp lines of demarcation are 
drawn here. We name those tissues whose cellular elements 
exercise the power of preparing food for other tissues or of 
excreting waste material ; glandular tissue, mucous membrane, 
serous membrane and skin form this class. 




Fig. 6. — Kidney of a cat. X590. a, Glomeruli; b, Loops of Henle or collecting 
tubules. Drawn by A. M. Hewitt. 




Fig. 7- — Medulated nerve fibers. Drawn by A. M. Hewitt 



Irritable Tissues. — Muscle and nerve are the sole oc 
cupants of this class. 



4 o PRINCIPLES OF OSTEOPATHY. 

The tissues thus far mentioned constitute the form and 
solid substance of a human cadaver. If tissues could live in- 
dependently of each other as amoeba live, then we might have 





Fig. 8. — Nerve cells, in different stages of development, from the cerebrum of a 
fetal rabbit two or three days before birth. The cells from i to 7 are Golgi 
cells of the first type. No. 8 is a Glia cell from the same preparation. X150. 
Original drawing by C. H. Phinney, D. O. 

life in this accumulation of cells, but since this is not possible 
we must add other tissues. 

Circulatory Tissues. — These are blood and lymph. 
They are vital to all that have just been mentioned. 

The blood and lymph are the media of exchange. 

The nerves are the media of communication. 

Blood and nerves complete the connection between all 
other tissues and fill us with wonder at the many phenomena 
caused by their activity. By considering blood as a tissue, we 
are not violating imagination nor becoming transcendentalists. 

"Every tissue is composed of two parts ; the cellular ele- 
ments and the intercellular elements. Upon the first of these 
depends the vitality of the tissue, while its physical properties 
are determined by the character of the second. The physical 
condition of the intercellular substances includes a wide latitude, 
varying from that of fluid, as blood or lymph, through all 
degrees of density until by the additional impregnation of 
calcareous matters, the well-known hardness of bone or dentine 
is attained." (Piersol.) 

Mechanical Principles. — Our next step is to consider 
some of the attributes of these several classes. 

Osteopathy has been built up on the mechanical idea of the 
body rather than the vital; i. e„ in the thought of the average 



PRINCIPLES OF OSTEOPATHY. 



osteopath, form and structure, mechanical pressure, leverage, 
bony pressure, etc., have preceded the more complex vital phe- 
nomena which make up the picture of disease in older schools 




F'.g. 9. — Blood Corpuscles under high magnification. 1, Groups of Red cells; 2, 
End view of Red cells; 3, Crenated corpuscles (Red); 4, Polymorphous Leuco- 
cyte; s. Mononuclear Leucocyte; 6, Polynuclear Leucocyte; 7, Eosinophyle 
corpuscle; 3, Transitional Leucocyte; 9, Rouleau of Red corpuscles. Drawn 
by A. M. Hewitt. 

of medicine. Therefore, in order to follow the subject along 
the lines of its development, we will consider the structural 
tissues first. 

Displacement by Violence — Passive. — Structural tis- 
sues may be displaced by violence. The human body receives 
a vast number of falls, slips, jars, etc., which are liable to 
destroy the delicate adjustment of its bony parts. The chief 
wonder is that we do not have more serious results in a larger 
number of cases. 

Up to the time of the advent of osteopathy in the field 
of medicine this etiological factor in disease was not taught. 
Slight structural displacements can not be successfully noted 
unless the diagnostician has been carefully trained in anatomy.- 
All the successes of the early osteopaths were achieved by 
hands trained to make use of anatomical therapeutics. 



42 PRINCIPLES OF OSTEOPATHY 






It is not enough that an osteopathic physician should be 
able to recognize improper positions of bony parts; his ob- 
servation and his thought do not halt here, but follow the 
normal physiological action in the immediate and remote areas, 
then he realizes what pathological conditions may result from 
the physiological perversion. 

Obstruction to Vital Forces.— Since structural tissues 
are surrounded by vital tissues, irritable and circulatory, we 
may state the next proposition as follows : Displaced 
structural tissues make pressure on irritable and circulatory 
tissues. This proposition, simplified, means obstruction to 
vital forces. When the displacement takes place far from the 
centers of vitality, that is, the spinal cord and brain, the re- 
sulting perversion of function is not very wide spread. For 
example, the displacement of a tarsal bone will not create the 
disturbance that would be found as the result of a vertebral 
or costal subluxation. 

The result of the pressure is a change in the normal 
metabolism in the deranged area. If the media of commu- 
nication and exchange are cut off by this pressure, then met- 
abolism is bound to suffer in the injured area or by reflex 
nervous irritability, a changed metabolism is found in a distant 
area. This does not mean that only points distal to the seat 
of injury will be affected because their means of communica- 
tion and exchange have been cut off, but that an area appar- 
ently having no direct connection with the injured part may 
show metabolic changes because its nerve supply is given off 
from the same central area, and, in want of a better word to 
express my meaning, acts in sympathy with the injured part. 

Cartilage may become subluxated in some localities and 
be the disturbing factor. For example, in the knee or temporo- 
maxillary articulations. Ligaments may be strained and the 
resulting thickening cause obscure pressure symptoms. This 
is especially true of spinal ligaments. 

Primary and Secondary Lesions. — Bear in mind that 
thus far we have considered all of our disturbances to be the 
result of external violence, and are hence primary etiological 
factors of disease. No perfect cure can be expected unless 



PRINCIPLES OF OSTEOPATHY. 43 

this primary disturbance is righted and obstruction to the 
vital forces removed. Early osteopathic literature noted 
especially these bony lesions and urged the osteopath to search 
diligently for them and remove them. The great value to 
humanity of this method is amply proven by a multitude of 
cases in every State. If all lesions were of this character 
and primary, there would be little need of my writing farther, 
but we are vital mechanisms, hence complexity of arrange- 
ment and reaction draw us on to interpret the phenomena met 
with in our practice. A lesion, according to osteopathic 
thought, is used to designate any derangement of tissue. When 
they are recognized or considered as primary lesions they are 
treated as the first cause, if they are recognized as resulting 
from other disturbances, then they are considered as secondary 
lesions, but this does not preclude the idea of treating them as 
primary and hence working a change in opposition to a vicous 
cycle of reflexes. A secondary lesion may be the result of 
a primary one and at the same time be the primary cause of 
another secondary lesion and so on from cause to effect and 
on again. Herein lies the opportunity of the osteopath to 
display his anatomical and physiological knowledge in fol- 
lowing these reflexes by a process of exclusion until he finds 
the primary one. This process of exclusion often requires a 
considerable time. 

Displacement by Muscular Contraction — Active. — Our 
next proposition in regard to structural tissues is as follows : 
They may be deranged by excessive activity of contractile 
tissue, muscle. This brings us to the consideration of a 
tissue which is both structural and vital, but since its form 
and attachments are merely for the purpose of allowing its 
vital qualities to affect other tissues, we are principally inter- 
ested in its vital attributes. 

Muscle contracts as the result of direct mechanical stimu- 
lation, such as a pinch or prick; or as a result of poisonous 
material in its blood supply ; or as a result of irritation of its 
controlling nerve, direct or reflex ; also in response to sudden 
temperature changes. 

With these four means of stimulation and the fact that in 



44 PRINCIPLES OF OSTEOPATHY. 






the normal body, the controlling nerve of a muscle can be 
stimulated by temperature, pressure or poisonous chemicals 
in its blood supply, the fact dawns upon us that since muscles 
attach to bones, ligaments, tendons and fascia, and are subject 
to all these forms of irritation, contraction cannot help causing 
a change in structural tissues, and a faulty alignment of struc- 
tural tissues will be manifested to the osteopath's fingers as 
lesions, primary, perhaps, to the minds of many, but in reality 
secondary. Another form of displacement of structural tissues 
may be the result of secretory tissues, their excessive activity 
being the result of derangement of nerve and blood supply. 
The derangement may be the result of direct or reflex irrita- 
tion to the controlling nerves. 

Summary. — Thus we have noted three forms of dis- 
placement of structural tissues ; the first purely the result of 
extrinsic forces, violence ; the second and third resulting from 
vital activities. Whether the displacement be a primary or 
secondary cause it may occasion the following results : The 
lesion is an obstruction to blood supply, which equals a 
changed metabolism in the immediate area, resulting in irri- 
tation to the nerves in the immediate area either as result of 
pressure or lack of proper food. This is followed by an 
altered blood supply in distant or reflex areas through action 
of vaso-motor nerves, causing changed metabolism in said 
distant or re-flex area resulting in weakened tissue through 
failure of proper exchange of food and waste elements. This 
decreases resistance to bacteria, hence opens the way to specific 
infection. 

To picture these changes more vividly we will state them 
in relation to some specific disease, diphtheria for instance 
The atlas may be subluxated as a result of violence, such 
as a hard fall or stepping off a curb without being conscious 
of its presence. The shock and consequent strain of the 
muscles causes contraction resulting in subluxation. Both 
the shock and the resulting subluxation affect circulation in 
the immediate area, thus changing the metabolism going on 
in the suboccipital triangles. From this troubled area im- 
pulses are carried to the superior cervical sympathetic gang- 



PRINCIPLES OF OSTEOPATHY. 45 

lion in such numbers and force that the normal action of this 
ganglion, vaso-constriction, is impaired. The nasal, laryn- 
geal and pharyngeal mucous membranes become congested, thus 
working a change in the metabolism of their cells which 
gradually decreases their normal resistance to bacteria. These 
weakened tissues which are exposed to the air are now in a 
condition to yield to an amount of infection far inferior in 
strength to what would be required to overcome normal re- 
sistance. 

This is an illustration of the osteopath's method of rea- 
soning carried through to the point of specific infection. 

The same train of reflexes may be originated by cicatricial 
tissue in any locality where the wealth of nerve connections 
or capillary circulation is sufficient to manifest the irritation. 

Contractile Tissue. — It has been noted that muscle is 
a structural tissue, but its vital attribute is of greater interest. 
The most distinctive thing about our bodies is their power 
to move spontaneously. We speak of being quiet, but are 
never so in life, we respond to every change about us, in- 
finitesimal changes in the atmosphere, every change is an 
evidence of muscular action. One-half of our bodies in 
weight consists of muscular tissue and contains about one- 
quarter of the whole amount of blood. It is muscular tissue 
which propels the blood and generates heat, in fact all of our 
functions depend on the muscles. 

Amoeboid Motion — Contraction. — Your studies in his 
tology will teach you the minute formation of muscular 
tissue, hence we need not spend time on that division of 
our subject. We know that the primative cell possesses the 
power of moving, called amoeboid motion, that in the pro- 
cess of differentiation of tissues muscular tissue is the spe- 
cialization of this attribute of the primitive cell. One form 
of epithelium, the ciliated, possesses power of motion in its 
cilia. Muscular tissue possesses the property of contraction, 
that is, the power to draw its extremities nearer each other. 
Owing to the various attachments of the muscles to the bones 
we enjoy the ability to make many motions. 

Stimuli. — Through the exercise of our wills our mus- 



46 PRINCIPLES OF OSTEOPATHY. 

cles contract, but muscular tissue will respond to other kinds 
of stimuli; for instance, if a muscle fiber is pinched it will 
contract, or if it is subjected to the action of a strong acid 
it will contract. Rapid temperature changes affect it also. 
We do not lose sight of the fact that in the normal human 
body, muscles are not directly exposed to the action of ex- 
ternal stimuli such as have been mentioned but they do re- 
spond to these stimuli under normal conditions through the 
transference of the stimulation to them by nerves. When 
studying the phenomena of muscular activity in the living 
human body, we are compelled to constantly reckon with the 
nerves which control the muscles. We, as normal beings, act 
according to our will. In order to control our muscles there 
must be a connection between the brain and the muscles. 
The motor nerves carry our willed action to the muscles. If 
these nerves are cut we lose control of the muscles in which 
the cut nerves end, but the muscles have not lost the power 
to contract. Contraction is a property of the muscle, not of 
the nerve ; the nerve conveys the normal stimulus which 
causes the muscle to contract. The sensory nerves which are 
in muscles and go to the central nervous system, convey to 
our brain cells a knowledge of how the muscles are respond- 
ing to our orders. 

The nerve cells in our spinal cord are able to control 
many motions which we are not conscious of, hence attitudes, 
and positions of the vertebrae are assumed without sensory 
nerves informing our consciousness. It is possible therefore 
that muscles governed by these spinal nerve cells may contract 
in response to mechanical, thermal and chemical stimuli with- 
out conscious sensation being registered on the sensorium of 
our brain. 

Direct and Indirect Stimulation. — Two propositions 
will make our position clear. First, Muscle will contract in 
response to direct mechanical, thermal, chemical and electrical 
stimuli. Second, Muscle will contract in response to indirect 
mechanical, thermal, chemical and electrical stimuli. We have 
to deal almost exclusively with the indirect stimuli. It is 
not probable that muscles ever contract as a result of direct 



PRINCIPLES OF OSTEOPATHY. 47 

stimulation while they are under nerve control. For them to 
be subject to direct stimulation would be disastrous to the nerv- 
ous system. In the case of burrowing parasites, trichinae, for 
example, there may be direct stimulation. A contraction of a 
muscle independent of nerve control while such control exists, 
is not conceivable; that is while the muscle has all the nerve 
connections intact between itself and the simplest kind of a 
nerve center. This fact compels us to consider all contractions 
of muscles as resulting from irritation of nerves, not of muscles 
directly. Motor nerves may be directly stimulated by sub- 
luxated bones, cartilage or by swelling, thus causing the 
muscles which they innervate to contract. Muscular con- 
tractions in the immediate and distant areas is coincident with 
all subluxations. As a result of chemical and thermal stimuli 
sensory nerves will pass their impressions to the motor side 
of a reflex arc and thus cause muscular contraction. 

Structural Tissues Affected by Muscular Contraction. 
A contracted muscle always exerts its influence on movable 
structures, bone, cartilage, tendon, fascia, skin ; or where 
muscle forms one of the layers of a hollow organ or vessel 
contraction lessens the caliber. Lessened size of blood vessels 
means lessened nourishment to the parts supplied by those 
vessels. Lessened caliber of bronchioles means lessened re- 
spiratory power, hence lessened oxygenation of the blood. 
When a muscle contracts it compresses its blood capillaries 
and raises blood pressure. If all the muscles of the body con- 
tract, as in violent exercise, blood pressure is enormously 
increased and the heart is put to a severe test. The relative 
effects on the whole circulation, caused by the contraction of 
one group of muscles might be small and yet be very detri- 
mental to local circulation in the contracted area. Alternate 
relaxation and contraction adds strength to a muscle, but 
continuous partial contraction, such as results from continued 
stimulation, not only results in destroying structural align- 
ment but injures the muscle substance. If the effects were 
all local, little attention would be paid to them but they es- 
tablish a chain of reflexes which manifest themselves end- 
lessly. 






48 PRINCIPLES OF OSTEOPATHY. 



Circulation of Blood in Muscle. — A comparison of the 
blood which enters a muscle with that which leaves it shows 
that, whereas the former is bright red, contains a relatively 
large amount of oxygen and small amount of carbonic acid 
gas, the latter is dark blue in color and its proportions of 
oxygen and carbonic acid gas are the reverse of the former 
and contains other ingredients the result of katabolism in 
the muscle and its food ; the temperature is higher in the 
latter than in the former. When a muscle is contracted con- 
tinuously it does not receive its full amount of blood and this 
causes lessened irritability of the muscle substance, the same 
is true if the quality of the blood supplied is poor or the 
muscle vein is obstructed so that the muscle cannot get rid 
of its waste products. Restoration of irritability may be se- 
cured by removing the above causes. 

Michael Foster has well stated the importance of the mus- 
cular tissue where he says that the whole of the rest of the 
body is engaged "(i) in so preparing the raw food, and so 
bringing it to the nervous and muscular tissues, that these 
may build it up into their own substance with the least trouble ; 
and (2) in receiving the waste matters which arise in mus- 
cular and nervous tissues and preparing them for rapid and 
easy ejection from the body." 

Effect of Contraction — Intrinsic. — The intrinsic effect 
of continuous muscular contraction is lessened activity of the 
muscle, hence lessened inter-change of food and waste products 
ending in decrease of muscle substance. 

Extrinsic. — The extrinsic effect is principally noted in 
the amount of heat produced and the pernicious effect on 
circulation, both locally and systemically. Above all, to the 
osteopath the nerve reflexes which are the result of mechanical 
pressure resulting from contraction over a nerve trunk, or 
from a bone subluxated by over- contraction of an attached 
muscle, are most interesting. 

Summary. — A muscular contraction may not cause 
widespread reflexes unless situated so as to mechanically irri- 
tate the nerve trunk. All muscular contractions along the 
spine are so situated that they may be considered irritating 



PRINCIPLES OF OSTEOPATHY. 49 

lesions, whether they are primary or secondary needs to be 
determined by careful physical examination and history. 

We pay little attention to the intrinsic effects of muscu- 
lar contraction or to the chemical changes in the blood stream 
as a result of such contraction. The structural changes with 
the resulting nerve reflexes are what we are most interested 
in. If the contraction is secondary to a bony lesion, it is 
frequently treated indirectly through reducing the subluxa- 
tion. If it appears to be primary, treatment may be applied 
to it directly or indirectly, i. e., by direct inhibitory pressure, 
stretching, inhibition of the motor nerve or thermally. 

Our reasoning concerning these lesions again follows 
from perverted structure to perverted function and may be 
stated much as before : The lesion is an obstruction to blood 
supply, which equals a changed metabolism in the immediate 
area, resulting in irritation to the nerves in the immediate area 
either as result of pressure or lack of proper food. This is 
followed by an altered blood supply in distant reflex areas 
through action of vaso motor nerves, causing changed meta- 
bolism in said distant or reflex areas, resulting in weakened 
tissue through lack of proper exchange of food and zvaste 
elements. This decreases resistance to bacteria, hence opens 
the way to specific infection. 



CHAPTER III. 



IRRITABLE TISSUE. 

A masterful knowledge of nerve tissue and its arrange- 
ment in the body to form the nervous system is an absolute 
prerequisite for success in osteopathic practice. Every vital 
phenomenon calls for interpretation by the skillful physician. 
Interpretation cannot be attempted without a definite knowl- 
edge of structure and function of that tissue which acts as a 
medium of communication between all other elements of the 
body. 






5o 



PRINCIPLES OF OSTEOPATHY. 



The name of our system, Osteopathy, calls attention pri- 
marily to osseous structure, but it is only in connection with 




Fig. 10. 



-Pyramidal and Polymorphous cells from the cerebrum of a man 6n years 
old. X1.50. a, Polymorphous cells; b, Pyramidal cells. 



its effects on the tissues of communication and exchange, vital 
phenomena, we are actually interested. 

All physiological phenomena are characterized by the 
manifestation of attributes of nerve tissue, irritability, con- 
ductivity and trophicity; motion, sensation and nutrition are 
the vital phenomena whose perversion constitutes disease. 
Therefore whatever the pathological condition may be, we are 
called upon to note a change in some one or all of these at- 
tributes of nerve tissue. 



PRINCIPLES OF OSTEOPA THY. 



5i 



We cannot proceed farther in a logical manner without 
frequent references to the special attributes of irritable tissue. 




Fig. 11. — Photomicrograph of a Purkinje nerve cell 
in the cerebellum, human. Golgi preparation. 

We will, therefore, devote this chapter to a special considera- 
tion of these attributes. 




fig. 12. — Photomicrograph of multipolar nerve cells in the anterior horns 
of the spinal cord. 



Nerve Tissue — Scarcely any thought of muscle is 
ever complete without the nerve impulse which controls the 



52 



PRINCIPLES OF OSTEOPATHY. 



muscle is also considered. For convenience sake we may' 
separate nerve and muscle when teaching their special attri- 
butes but for all practical purposes they are never separated. 




Fig. 13. — Drawn by J. E. Stuart, D. O. 



The elucidation of our subject requires us to call your 
attention to some facts in physiology of nerve tissue which 
are essential to the foundation of our system of therapeutics. 
The nervous system consists of sending, conducting and receiv- 
ing elements, that is, cells, fibers and end organs. It is the 
physiology of these elements, singly and en masse, which is 
of paramount importance in osteopathic diagnosis and thera- 
peutics. 

Irritability. — Muscle and nerve are both irritable, but 
we pay no attention to the irritability of muscle because un- 
der normal conditions we do not see any evidences of specific 
muscular irritability. We view muscular irritability as the 
result of nerve irritability. Therefore nerve tissue is the 
chief irritable tissue. Irritability is an attribute of cell proto- 
plasm whereby chemical and physical phenomena are enacted 
in response to irritants. Irritants may be mechanical, chem- 
ical, thermal and electrical. Practically all that physiologists 
know of the reactions of nerve tissue to irritants has been de- 
rived through experimentation by means of the electrical cur- 
rent. Osteopathists are bringing to light many facts con- 



PRINCIPLES OF OSTEOPATHY. 53 

cerning mechanical stimulation. Hydrotherapists have dem- 
onstrated the utility of thermal stimuli. Drug therapy makes 
use of the chemical form of stimulation. 

Conductivity. — Nerve tissue is not only irritable ■ but 
possesses the ability to transmit its irritability to other tissues 
and cause certain activities to be initiated there. Conductivity, 
the second vital attribute of nerve tissue, is the power to 
carry impulses from the point of irritation to other points in 
the nervous system. Irritability would be of small moment if 
conductivity were not present to transmit the message to the 
center and arouse response. 

The nerve cell and its axis-cylinder are a continuous 
mass of protoplasm and as long as the continuity is maintained 
conductivity will be maintained. 

Trophicity. — The third attribute of nerve tissue, tro 
phicity, is very poorly understood. We do not use this term 
here to represent so much the nutritional influences of the 
cell-body over its axis-cylinder as the influence exerted by 
nerve tissue over other body tissues, causing them to grow 
and prosper. This nutritional influence over other tissues is 
an attribute which we are compelled to note quite frequently 
in practice. There are individuals in whom motion and sen- 
sation are normal but nutrition fails, hence we note that in 
some cases mechanical lesions may cause only a slight change 
in the nerve tissue upon which it infringes, and this change 
is manifested by variation in nutrition of the part controlled 
by the irritated nerve It is probably this attribute of nerve 
tissue which is perverted or lost when the tissues refuse to 
take up certain chemical elements which are ordinarily nor- 
mal to them ; for example, iron. 

In osteopathic practice we consider nutritional disorders 
as being the result of perverted trophic influence of nerves. 
Of course in cases where it is known that the ingested food 
does not contain the required element or elements we must 
regulate the diet. But there are many cases where all con- 
ditions appear normal except that the tissues do not take up 
nourishment as they should. In these cases we search for 
lesions in the same way we would if motion or sensation 



54 PRINCIPLES OF OSTEOPATHY. 

showed perversion or loss. This phase of our subject can 
best be considered at another time. 

Unity of the Nervous System. — The unity of the ner- 
vous system is a structural fact, and this brings deep and 
superficial areas in close relation. Every portion of the body 
is able through the medium of the nervous system to work 
in harmony with every other part. 

Physiologists divide the nervous system into central and 
peripheral portions, but for practical purposes this division 
is of little use to us when attempting to make use of the irri- 
tability and conductivity of the nervous system for thera- 
peutic purposes. 

Since all portions of the nervous system are connected 
there must be some place where impressions made upon ter- 
minal nerve filaments may be assembled, co-ordinated and re- 
sponded to harmoniously. Wherever large numbers of nerve 
cells are assembled we expect to find such duties performed. 

Mechanical Irritation. — We have noted in the previous 
lecture that mechanical pressure made upon nerve fibers by 
subluxated bone or cartilage, contracted muscle or thickened 
ligament will set up changes in the protoplasm of nerve tissue. 
"Mechanical applications to nerve and muscle first increase 
and later lessen and destroy the irritability. Thus pressure 
gradually applied first increases and later reduces the power 
to respond to irritants." (Lombard, in American Text-Book 
of Physiology.) These structural displacements in the human 
body act as mechanical irritants to nerve tissue changing the 
chemical and physical condition of the protoplasm and thus 
altering its irritability, either plus or minus according to the 
intensity of the stimulation. The displaced structures may 
have other detrimental influences on nerve tissue, for in- 
stance the pressure brought to bear on the nourishing liquids 
surrounding the nerve, i. e. the blood and lymph, may cause 
sufficient chemical change in these liquids to materially affect 
irritability of the protoplasm of the nerves which they are 
expected to nourish. 

Conductivity is not destroyed by these slight mechanical 
pressures. If the protoplasm of the cell and axis-cylinder 



PRINCIPLES OF OSTEOPATHY. 55 

were unable to conduct impulses and project them in such 
manner as to reach other cell bodies of the nervous system 
our work would be very limited. Conductivity depends on 
the continuity of protoplasm. The mechanical irritations we 
deal with in osteopathic practice seldom destroy conductivity. 
If they did do so, they would cease to be irritants the moment 
conductivity was lost. Other irritants may act for a time on 
the severed portions of protoplasm but the original lesion 
would have destroyed the continuity of the protoplasm. 

Double Conduction. — Double conduction is another 
physiological fact which explains to some extent the results 
observed in osteopathic practice- when pressure is made over 
nerve bundles ; but the complexity of fibers in the nerve 
bundle makes it impossible to say positively whether the cen- 
tral and peripheral phenomena are the results of double con- 
duction or the presence of afferent and efferent fibers. Since 
we know that nerve bundles are made up of both afferent and 
efferent fibers there is no particular need for us to explain 
results by double conduction. 

Nerve Bundles. — We have been dealing thus far with 
irritability and conductivity as attributes of nerve tissue. In 
a general way we have viewed the results of mechanical 
pressure on a solitary nerve fiber, not caring whether it is 
afferent or efferent or what its function. The next step is 
the consideration of nerve bundles. The fibers composing a 
nerve bundle may be efferent or afferent so far as direction 
of impulse is concerned. Efferent fibers may be further dif- 
ferentiated by the names, motor, vaso-motor, secretory ac- 
cording to the structures in which they end. Afferent fibers 
are usually termed sensory to denote their function of car- 
rying impulses to the central nervous system. Nerve trunks 
contain all of these various fibers, therefore, pressure will 
irritate all of the fibers and conductivity of individual fibers 
will transmit the impulses in the direction of the normal nerve 
impulse, thus causing contraction in the voluntary or involun- 
tary muscles or activity of secretory tissues ; sensory impulses 
will be transmitted to the central nervous system and will pur- 
port to come from the terminal distribution of the sensory 






56 PRINCIPLES OF OSTEOPATHY. 



nerve. If the afferent impulse is such an one as will reach 
the patient's consciousness, we find that the central cells are 
misled as to the location of the stimulus and hence manifest 
a response in the supposed area. It is not necessary for the 
patient to be conscious of any irritation in order to bring about 
this result. 

The Central Nervous System. — The organization of 
the nerve bundle complicates our ideas of irritability and con- 
ductivity in the protoplasm of the cell and axis-cylinder of a 
nervous unit. Complexity of action and reaction increases as 
we near the central nervous system. We have considered that 
all impulses generated in the protoplasm of a nerve cell and 
axis-cylinder have been transmitted to all parts of that unit 
of nerve tissue, but has not in any way influenced any other 
unit. We have not considered the relations of cell bodies in 
the central system. It is sufficient for our present purpose 
to note that the afferent fibers enter the spinal cord as the 
posterior roots and that their cells are in the ganglia of these 
posterior roots. 

The efferent fibers leave the cord as its anterior roots and 
their cell bodies are located in the anterior cornua of the gray 
matter of the cord. Upon careful study of the spinal cord 
there are found other cells and axis-cylinders which do not 
leave the cord but serve to connect the afferent and efferent ele- 
ments and distribute impulses within the cord. These latter 
are found in enormous numbers in all portions of the central 
nervous system. 

Segmentation. — The first fact of great interest to us 
osteopathically, is the segmentation of the spinal cord. This 
is only relative in character, but yet is apparent not only his- 
tologically, but pathologically. We note that according to dis- 
tribution of afferent fibers in the spinal cord impulses are dif- 
fused both above and below the point of entrance. The cell 
bodies of the anterior roots are also somewhat diffused, but in 
practice we note that afferent and efferent impulses seem to be 
correlated within comparatively narrow limits in the spinal cord. 
How the impulses set up in the protoplasm of an afferent 
fiber are transmitted from it to the protoplasm of other cells 




Pig. 14. — Camera lucida drawing of a golgi preparation, made by J. E. Stuart, D. O. 



WTi 





3 ■ 



Fig. 15. — Photomicrograph of a cross-section of the spinal cord. Golgi preparation. 
Photographed by T. O. Hunt, D. O. . 



58 



PRINCIPLES OF OSTEOPATHY. 



located in the spinal cord and thence transmitted to the pro- 
toplasm of efferent cells is not known, nor is it necessary for 
us to thoroughly understand the method in this instance so 
long as we recognize the results. Our specific knowledge must 
comprehend the exact point of entrance to and exit from the 
spinal cord of each nerve bundle and the peripheral distribu- 
tion of the same. Having a knowledge of the structure, the 
function comes naturally as a result. 

Segmentation refers to structure, and thus the next point, 
reflex action, which is physiological, is a logical sequence. 

Reflex Action. — The central nervous system is con- 



JTIustlf jj tKrr; 




Tfurvi- tflL 



Som* ;By- paths of JUrtfes. 
Concerned » a th*> btmplesl" 

Fig. 1 6. —Drawn by J. E- Stuart, D. O. 

stantly receiving impulses from afferent fibers and co-ordinat- 
ing them. We are almost entirely dependent on reflex action 
for the effects we secure on deep tissues. Our manipulations 
affect sensory nerves in skin, muscle and synovial membrane. 
These impulses are carried to the central nervous system and 
transformed into efferent impulses. 

During life there is no period when the body is not de- 



PRIXCIPLES OF OSTEOPATHY. 59 

pendent on external stimuli. These ordinary mechanical and 
thermal stimuli keep a constant stream of impulses entering 
the central system to be translated into stimuli of muscle and 
gland. This ceaseless play of reflexes may vary in intensity, 
but so long as life lasts they are demonstrable. We expect 
the reflex to be initiated by the sensory side of the reflex arc, 
therefore the intensity of muscular contraction and glandular 
secretion is governed by the intensity of the initiatory impulse. 
This is certainly the case under normal conditions, but in the 
case of a subluxation, muscular contraction and secretory ac- 
tivity in the area of distribution of an irritated nerve trunk 
may be increased primarily, i. e., without the iniatory impulse 
being originated in a sensory nerve. The pressure on the ef- 
ferent fibers to muscle and gland stimulates them without the 
intervention of the central nervous system. Our methods of 
diagnosis take into consideration both the mechanical lesions 
which cause direct stimulation of a nerve trunk, and those 
pathological conditions which are the result of intensified nor- 
mal stimuli. 

Practical Application. — The segmental structure of the 
cord and the reflex action manifested therein show that on the 
whole, a definite muscle group and a definite cutaneous area 
arc innervated from a limited portion of the central system. 
Therefore we may count on the stimuli originated in the cuta- 
neous area being reflexed to the definite muscular area. 

An example in practice is as follows : patient's head is 
drawn slightly to the left side. Complains of pain shooting 
to the left shoulder and over the left clavicle whenever move- 
ment is attempted. History of exposure to draught of cold 
air. Physical examination discloses contraction of left trape- 
zius, levator anguli scapulae and scaleni. Pressure upon these 
muscles causes pain. When instructed to take a full inspira- 
tion, patient says he can not on account of pain which is sharp 
and darting in character and radiates over the infraclavicular 
portion of the left chest. When we consider the muscles in- 
volved and the area of painful sensations our attention is im- 
mediately called to a definite segment of the cord, in this case 
the point of origin of the third and fourth cervical nerves. 



60 PRINCIPLES OF OSTEOPATHY. 

The cold air striking the skin, intensified the normal stimuli, 
and the efferent impulses from that segment of the cord were 
intensified as the direct result of the cutaneous irritation. The 
point of irritation, the cutaneous area, governed the location 
of the reflex. So long as the original stimulus was only mod- 
erately intensified all the reflexes emanate from one segment 
of the cord, but if they had been more intense or continued 
longer, we might have found a greater area reflexly affected. 
The stimuli which would have reached the cord would have 
been more widely diffused above and below the point of en- 
trance. 

Since we know that the highly organized spinal cord of 
man is not to be compared with the same structure in lower 
forms of animal life, and that segmentation in it is illy de- 
fined, the practical question arises as to how much dependence 
we can put upon reflexes in the human nervous system. "Will 
the reflexes guide us to definite segments of the spinal cord? 
Experience teaches us that a thorough knowledge of the dis- 
tribution of afferent and efferent nerves in man will interpret 
reflexes with sufficient exactness and invariably lead the in- 
vestigator to a spinal segment which is itself affected or is co- 
ordinating impulses from a known sensory area. 

Efferent Fibers. — When we follow the efferent im- 
pulses to their points of distribution our work is greatly com- 
plicated. To reason from contracted voluntary muscle to cu- 
taneous sensory area is a comparatively simple procedure; 
but to start with the sensory impulse and trace it through 
the central system, and. thence along efferent pathways, to esti- 
mate its final effects as mechanical work done by muscle and 
gland in many combinations, requires a' considerable knowl- 
edge of structure and function of all parts of the human 
system. 

Many of the efferent fibers of the cerebro-spinal system 
take their course through the sympathetic ganglia and are 
distributed in that system to plain muscle and secretory cells 
of the body. It has been ascertained by various careful ob- 
servers that these efferent fibers, after entering the sympa- 
thetic system, either er»d in the ganglia nearest their point of 



PRINCIPLES OF OSTEOPATHY. 6r 

emergence from the cord or pass up or down to ganglia above 
or below the one originally entered. Some fibers pass through 
these ganglia and end in the more peripherally placed plex- 
uses. 

Sympathetic Ganglia. — Wherever nerve cells are accu- 
mulated a certain amount of independent action is probably 
carried on. Terminal filaments of efferent fibers in sympa- 
thetic spinal ganglia are in relation with a large number of 
cells and the number of fibers leaving the ganglion is greater 
than those entering. Therefore diffusion of impulses from 
these ganglia must be very great. The accumulation of sen- 
sory impulses in these ganglia may be equally as great. Each 
ganglion must have a dominant influence over a certain vis- 
ceral area, and this influence is subsidiary to the control ex- 
ercised by the segment of spinal cord to and from which the 
larger number of its fibers proceed. 

Diagnosis — Objective Symptoms. — Osteopaths have 
in great measure discarded subjective symptoms, believing 
that they are of very doubtful value in the large proportion 
of patients. Having discarded subjective symptoms, they 
have developed a method which gives equal or better re- 
sults. It has three phases, two of which are structural and 
one which is partially subjective. First in order comes, skel- 
etal alignment ; second, muscular tone; third, condition of 
reflexes. These three divisions all come under the general 
head of palpation. 

As an illustration of the value of objective in preference 
to subjective symptoms, the following case is of considerable 
value. The gentleman whose physical condition is practically 
illustrated in Figs. 17 and 18 was examined in the clinic of 
the Pacific School of Osteopathy. He had been operated 
on surgically for a peculiar enlargement just above and ex- 
ternal to the right knee. The line of the incision is shown 
in Fig. 17. He stated that he had suffered pain at this point 
during more than a year, and his physician had decided that 
there was a tuberculous condition of the bone. The operation 
did not confirm this diagnosis. No unhealthy tissue was 
found. 



62 



PRINCIPLES OF OSTEOPATHY. 




Fig. ly. — Photograph of a case illustrating atrophy of the muscles of the right leg 
due to faulty trophic influence of the nerve cells in the spinal cord. The scar 
just above the right patella is superficial to a hypertrophic condition of the bone. 



PRINCIPLES OF OSTEOPATHY. 63 

We noted his peculiar handling of the leg when walking, 
compared both limbs from toe to hip and discovered a marked 
difference in size, as is indicated in the photograph. By fol- 
lowing the course of the nerves to the spinal column, we dis- 
covered that the muscles on the right side of the spine were 
atrophied in proportion to those of the extremity. Fig. 18 
shows the fact that the atrophied condition extends into the 
interscapular region, and the spinal column is bent. 

The patellar tendon reflex was lost on the right side, but 
present on the left. The right leg was ataxic, but the left 
leg was normal, thus presenting what might be called a uni- 
lateral locomotor ataxia. If this man's surgeon had taken 
the care to examine him from an objective structural stand- 
point rather than to depend on the subjective symptoms, it is 
highly probable that no operation would have been performed. 
Our examination demonstrated that this man's structural con- 
dition was at fault, and that the trophic influence of a part of 
his nervous system was being gradually lost. Both the motor 
and sensory nerves were acting feebly. 

It might be asked, "How could one secure a spinal reflex 
from the stomach?" In what way would the finding of such 
a reflex surpass ordinary methods of examination? 

The neurologist, when making examination of a patient 
suffering with some faulty condition of the sensory or motor 
portion of the nervous system, must possess a definite knowl- 
edge of the origin, course and distribution of nerve trunks in 
order to locate accurately the position of the lesion. The 
osteopath pursues the same method of examination, but fol- 
lows it farther. His investigation takes into consideration 
the dispersion of efferent fibers in the sympathetic system 
and the sensory impulses received from the spinal cord from 
that system. 

Edinger quotes Exner as follows : "One must not sup- 
pose that all the impulses reaching the spinal cord by the 
sensory roots are identical with what is ordinarily called 'sen- 
sation.' In order that an impression be perceived, it is not 
sufficient that it be conducted to the spinal cord, but it must 
be farther carried up, from the place where the peripheral 



64 



PRINCIPLES OF OSTEOPATHY. 




Fig. 1 8. — General view of case illustrated in the 
preceding figure. The spinal curvature is 
clearly indicated. Patellar tendon reflex ab- 
sent on right side but present on the left. 



PRINCIPLES OF OSTEOPATHY. 65 

part ends, to the cerebral cortex. There is, however, no doubt 
at all that all these higher connections are few in number, and 
that contrasted with the multitude of fibers in the posterior 
roots, the number of such cranial connections is quite small. 
This alone makes the conclusion possible that there are, in- 
deed, many sensory impressions which arrive at the spinal 
cord, but that we are aware of but few of them at the time. 
All the viscera of the body, as the staining method has dis- 
tinctly shown, are traversed by an altogether unexpectedly 
large number of nerves, and their arrangement and course, 
their relations to blood vessels and glands, and to muscle 
fibers, bones, and enamel makes it more than probable that 
there is, in this connection, a large system which serves es- 
sentially to regulate impressions and reflex action." Anatomy 
of the Central Nervous System of Man and of Vertebrates in 
General. — Edinger. 

Co-ordination of Sensations. — It is the reflexes men- 
tioned in this quotation in which we are interested. Sensa- 
tion and perception are dissimilar. Sensations from the vis- 
cera are co-ordinated in fairly well-marked areas of the spinal 
cord, and when these sensory impressions are intense the ef- 
ferent fibers of the spinal cord manifest the condition exist- 
ing in a visceral area by causing an abnormal condition of 
muscular tone in the intrinsic muscles of the back. This con- 
tractured condition of the muscles is not the only evidence 
of the visceral reflex. Pressure on the contracted muscle 
causes pain. The intensity of the aesthesia is usually in pro- 
portion to the visceral irritation. Even though the patient 
does not say in so many words that there is pain on slight 
pressure, the examiner, if his palpation is good, can detect 
the reflex in the action of the muscle. 

Example. — A patient comes to an osteopath desiring 
to be examined. He does not vouchsafe any information as 
to his condition, merely saying, "I want you to examine me 
and find out what is the matter with me." This is a chal- 
lenge to the skill of the examiner and calls for something be- 
sides a long-distance catechising as to subjective feelings. 
The osteopath proceeds with absolute precision to determine 



66 PRINCIPLES OF OSTEOPATHY. 






the condition of his patient's structural formation, (i) Skel- 
etal alignment, (2) muscular tone, and (3) segmental spinal 
reflex. Each yields valuable information. The examiner's 
fingers may develop a reflex around the sixth dorsal spine. 
This is noted as a reflex from the gastric area. Testing the 
segments above and below this will show how great a section 
of the cord is irritated and will be an indication of the extent 
of the internal irritation, i. e., whether other portions of the 
digestive tract are affected. The reflex might extend as far 
as the fourth dorsal and still indicate the gastric area. Find- 
ing the reflex at the sixth dorsal spine has directed the attention 
of the examiner to the gastric area and has located a point 
from which further examination is to proceed. Percussion 
over the stomach would reveal other facts, and then the ex- 
amination would be pursued along general lines of physical 
diagnosis to determine the character of the gastric disorder. 

The moment the examiner centers his examination on 
the stomach, the confidence of the patient is assured. Is 
not this confidence greatly to be desired in every case? Is 
it not a force which compels the patient to follow the direc- 
tions of his physician in matters of diet and hygiene? 

In this example we have illustrated the attributes of nerve 
tissue, (1) irritability, (2) conductivity. Other conditions 
which make this illustration possible are ( 1 ) muscular con- 
traction in response to nerve stimulation, (2) segmentation 
of the spinal cord, (3) reflex action. 

We have added nothing new to the world's knowledge 
of nerve tissue, but we have applied general knowledge of this 
tissue to specific uses. We have taken the results of labora- 
tory experiments and made them practical methods in the 
detection and alleviation of disease. It appears to us that 
sufficient research work has been done on the nervous sys- 
tem by medical men and sufficient general conclusions drawn 
from their investigations to justify all branches of the pro- 
fession in making more extensive use of such data. The 
correlation of laboratory data with the results of clinical ex- 
perience make the foundation of osteopathic practice at the 
present time. By this bold application of knowledge, which 



PRINCIPLES OF OSTEOPATHY. 67 

to the medical profession at large has been regarded as specu- 
lative and at least impracticable, osteopathy has gained an 
impregnable position in the healing arts. 

Laboratories make scientists, not physicians ; hence phy- 
sicians have not always grasped the full significance of the 
scientific discoveries in physiology and applied them to thera- 
peutics. 

Whatever osteopathy may at present possess or gain in 
the future, is due solely to a close adherence to the facts of 
anatomy and physiology ; and the application of these funda- 
mental facts to scientific therapeutics. 



CHAPTER IV. 



CIRCULATORY TISSUE. 

From the histological standpoint, blood conforms to the 
general definition of a tissue, being composed of a cellular 
and intercellular substance. The intercellular substance being 
liquid, differentiates it greatly from other tissues. It con- 
tains cellular elements which differ from each other in form 
and function. Then, too, it is a moving tissue enclosed in a 
system of closed tubes. 

Functions. — The blood performs many functions. 
These may be stated in general terms as follows : 

1. To convey nutrition to all other tissues. 

2. To remove waste products from the tissues. 

3. To convey oxygen for tissue respiration. 

4. To distribute heat. 

5. To repel invasion of bacteria. 

Lymph. — Lymph is another liquid tissue, less rich in 
corpuscular elements, but greater in total bulk than the blood. 
The lymph comes in direct contact with the elements of the 



68 PRINCIPLES OF OSTEOPATHY. 

tissues. Stewart states the relationship tersely where he says, 
"The blood feeds the lymph and the lymph feeds the cell." 

Since we think of individual tissues as possessing some 
one well developed attribute or function, it is well to call blood 
and its congener, lymph, the media of exchange. This ex- 
pression covers at least four of the functions previously men- 
tioned. 

With this comprehensive but short statement of the re- 
lation of these liquid tissues to the structural, contractile, irri- 
table and secretory tissues, it seems hardly necessary to dis- 
cuss so self-evident a proposition as that health primarily de- 
pends on a perfect circulation. It is not even necessary to add 
to this the fact that the blood should be pure, because under or- 
dinary circumstances if the blood circulates properly it will be- 
come purified. 

All schools of medicine have a therapeutic principle 
around which their practice is built. From its earliest incep- 
tion the osteopathic idea has been that a perfect circulation 
is the foundation for perfect health. 

Blood. — We will attempt to outline the general prop- 
erties of the blood, and thus state the basic facts of the chem- 
istry, histology and physiology of this tissue, which plays 
such an important part in osteopathic therapeutics. 

Its color in the arteries is bright red, and in the veins is 
bluish purple. The difference in color is due to the relative 
amount of oxygen and carbon dioxide present in each. Ar- 
terial blood has more oxygen and less carbon dioxide, more 
extractives, salts and sugar, and less urea than venous blood. 
Arterial blood is usually warmer than venous. It is changed 
to a darker color when respiration is imperfect, or when the 
individual is subjected to a higher temperature. Venous blood 
becomes brighter when the individual is made to breathe pure 
oxygen. It is also brighter in the veins which drain an act- 
ively secreting gland or resting muscle. The temperature 
varies according to the location, that in the hepatic vein be- 
ing the warmest. The blood in the visceral is warmer than 
that in the cutaneous vessels. 

The proportion of blood to body weight is about one- 



PRINCIPLES OF OSTEOPATHY. 69 

twelfth of the whole, i. e., twelve pounds of blood in a body 
weighing" 150 pounds. This amount of blood is distributed 
approximately as follows : One-fourth to the heart, lungs and 
great blood-vessels ; one-fourth to the liver ; one-fourth to the 
resting muscles ; one-fourth to the remaining organs." There 
is not blood enough in the body to maintain all of its activities 
at the maximum at the same time. Therefore it is difficult to do 
the best physical or mental labor just after digestion has be- 
gun. The splanchnic blood vessels are capable of containing 
so large a proportion of the whole amount of blood that death 
may result from lack of sufficient blood returning to the heart 
to cause it to beat. 

Blood Corpuscles, Red. — The physical constituents of 
the blood are the red and white corpuscles and platelets. 

The red blood corpuscles are the oxygen carriers.. It is 
estimated that the combined surface of the corpuscles con- 
tained in five litres of blood would be 2,816 square meters, 
i. e., over one-half acre. These cells retain a special form 
but possess sufficient elasticity to allow them to pass through 
capillaries of a diameter less than their own, and then assume 
their normal contour. They are quickly changed in appear- 
ance by a change in the specific gravity of their surrounding 
media. As before stated, the red corpuscles are the oxygen 
carriers. Their function depends on the presence of a sub- 
stance called haemoglobin, which unites readily with oxygen 
to form oxyhaemoglobin. Haemoglobin is a very complex 
substance, containing carbon, nitrogen, sulphur, iron and ox- 
ygen. 

It is commonly estimated that one cubic millimeter con- 
tains 5,000,000 red corpuscles. This number varies accord- 
ing to age, sex, nutrition, and altitude. 

Investigations seem to prove that these cells are derived 
from the red marrow of bone and end their life in the spleen 
and liver. 

White Blood Corpuscles. — White blood corpuscles 
have been known since 1770. They are far less numerous 
than the red corpuscles, colorless, and possess amoeboid mo- 
tion. There are several varieties, grouped according to stain- 



7o PRINCIPLES OF OSTEOPATHY. 

ing reaction or miscroscopic structure. Not all possess amoe- 
boid motion. Probably seventy per cent have well denned 
power of movement. 

"It is indeed a question if the different forms of leuco- 
cytes are distinctive histological elements having independent 
origins and functions, or whether they do not, after all, rep- 
resent different stages in the development of a single cell, 
the lymphocytes representing an early, and the polynucleated 
leucocytes the last stages." 

The leucocytes are present in the blood in proportion to 
the red blood corpuscles about one to five hundred. Their 
number increases "after digestion, hemorrhages, pregnancy, 
in diseases in which suppuration occurs, and in leucocythae- 
mia." Fasting decreases their number. 

"Leucocytes are more numerous in the capillaries and 
veins of the spleen, liver, glands and intestinal mucosa than 
in the corresponding vessels of the skin, muscles, and general 
cellular tissues." 

The functions of these cells are many and varied. A 
white blood corpuscle may be considered as an unmodified 
cell retaining all attributes of the amoeba. Because of its 
independent movement, observers have called it a "wander- 
ing cell." They have the power to enter all tissues, passing 
from the plasma through the vessel-wall into the perivascular 
tissue. They re-enter the blood current with the lymph. This 
process of migrating is continually going on, but is greatly in- 
creased by pathological conditions. This action of the white 
cells is known as "diapedesis." 

After leaving the blood stream in response to some path- 
ological condition of the tissues, they may either re-enter the 
circulation, be organized into repair tissue, or die and become 
pus cells. 

Some of these cells have been observed to surround and 
dissolve foreign substances, and are hence called phagocytes. 
Not all leucocytes are phagocytes, nor is this function lim- 
ited to wandering cells. Some endothelial cells also possess 
this function. Metschnikoff has stated a theory of immunity to 
various bacterial diseases based on this phagocytic function. 



PRINCIPLES OF OSTEOPATHY. 71 

These leucocytes or their products are concerned in the coag- 
ulation of the blood. 

The origin of the leucocytes is supposed to be the lymph 
glands, since more cells appear in the fluid leaving than in 
that entering the glands. 

Little of a definite character is known of the blood plat- 
elets. Fibrin is an albuminous substance which appears when 
blood coagulates. It is concerned in the stopping of hem- 
orrhages. 

The scope of this chapter does not contemplate a close 
research into all the constituents of the blood, but we de- 
sire to impress upon our readers the universality of function 
possessed by the blood. 

Chemical Constituents. — The chemical constituents of 
the plasma are very numerous, and it would require consider- 
able space to even enumerate them. There are inorganic and 
organic substances, some of which act as food for the tissues, 
others being the result of katabolism. 

Aside from the chemical constituents, there are many 
ferments. Besides the well known fibrin ferment, there are 
diastatic, glycolytic, lipolytic ferments. Serum also possesses 
a globucidal and bactericidal action. 

From this suggestive review of definite constituents of 
the blood, it will be readily noted that our classification of 
the functions of the blood is not too broad. 

Distribution of the Blood. — Granting that the blood 
possesses all these functions, the question still confronts us. 
How can we affect its distribution? This question leads us 
to a consideration of the physiological distribution of the 
blood. It is believed by the writer that nothing besides the 
use of water has so great an effect on the circulation of the 
blood as manipulation according to osteopathic methods. 
These methods do not depend on a mere physical assistance 
of the venous flow by means of centripetal stroking, such as 
is employed by a masseur. Effects on circulation are obtained 
in nearly all cases by knowing where definite nerves which 
control the action of the heart and blood vessels are placed 
and what their action in response to irritation may be. All 



72 PRINCIPLES OF OSTEOPATHY. 

manipulations are given with a definite knowledge of the lo- 
cation of blood vessels and the nerve centers which control 
their variation in calibre. The response secured is a new co- 
ordination of the whole circulation brought about under the 
control of the nerve centers. Compression of the carotids by 
the fingers will lessen the amount of blood flowing to the 
brain, but such a compression has no effect after the fingers 
are removed. From the osteopathic standpoint this proced- 
ure would be considered useless. Physiological experiments 
have demonstrated that the blood vessels of the head and 
brain will contract in response to stimuli from definite areas ; 
therefore, osteopaths treat these areas and thus secure a re- 
adjustment of the entire circulation which is more lasting 
than can possibly be secured by definite compression. 

It has been stated that the blood is contained in a closed 
system of tubes. A short resume of the most important points 
in the anatomy and physiology of the circulation may pre- 
pare us for a clearer insight of the modus operandi of os- 
teopathic methods. 

The Circulatory Apparatus. — The circulatory appa- 
ratus consists of the heart, arteries, capillaries, veins and lym- 
phatics ; some writers include the spleen. 

Muscular tissue is found in the heart, small arteries and 
veins. The heart is practically all muscle, and its contrac- 
tions are governed by two sets of nerve fibers from the cerebro- 
spinal system, the first set is called accelerator; second, in- 
hibitory. 

Likewise, the small arteries and veins have two sets of 
fibres which increase and decrease the intensity of the contrac- 
tion of their muscular fibres, and thus change the calibre of 
the vessels. 

The capillaries are short, narrow tubes, having a thin 
wall composed of nucleated cells which possess the power 
of contraction. So far as known, the capillaries expand and 
contract in response to the degree of physical pressure exerted 
by the blood current coming from the arterioles. Thus the 
change in the calibre of the capillaries is passive. The lym- 
phatics begin in small irregular spaces in the cellular tissue out- 



PRINCIPLES OF OSTEOPATHY. 73 

side of the blood vessels. They are found in direct relation 
with the cells of perivascular tissues, thus bringing the lymph to 
each cell. These openings lead to small lymphatic vessels which 
convey the lymph to the lymphatic glands which are situated 
so as to filter out the impurities, after which it is emptied 
into the venous circulation by the lymphatic ducts. The lym- 
phatic vessels possess power of contraction. The lymph equals 
about one-third of the body weight. 

The blood is a passively moving tissue. It is kept in 
constant circulation within a closed system of tubes by a com- 
bination of forces. The propulsion of the blood is almost 
entirely accomplished by the contraction of the heart. This 
initial force is supplemented by the aspiration of the chest dur- 
ing respiration, and the contraction of the skeletal muscles 
of the entire body. It is a debatable question whether or not 
the muscular coat of the arterioles and venules assist in the 
direct propulsion of the blood passing through them. 

It is the function of the heart to maintain a compara- 
tively uniform tension of the blood in the large arteries. The 
arterioles and capillaries are concerned in maintaining re- 
sistance to the passage of the blood. The degree of resist- 
ance in the capillaries, in large measure, determines the amount 
of nourishment received by the tissues. The relation between 
capillary resistance to the passage of the blood and the meta- 
bolism carried on in perivascular tissues is a point of great im- 
portance. The current of blood ordinarily passes through the 
capillaries very slowly, at a rate of one inch in two minutes, 
and under low tension, thus giving ample opportunity for the 
escape of nourishing material for the surrounding tissues. 

Tension in the arteries is maintained by three factors : 
i. The initial force of the heart beat; 2. Friction in the 
vessels ; 3. Elasticity of the vessel walls. The first and 
third of these factors are under nerve control which act ac- 
cording to a large number of stimuli. 

The capillaries being passive in action, the tension of the 
blood stream in them is mainly dependent on the tension in 
the arterioles. It may be profitably noted that after the initial 
impulse is given to the blood stream by the heart, the distri- 



74 PRINCIPLES OF OSTEOPATHY. 

bution of this blood depends solely on the arteries, arterioles 
and capillaries. This peripheral distributive mechanism is 
therefore responsible for the nutrition of the tissues, and its 
resistance oifered to the passage of the blood, regulates the 
amount of force exerted by the heart. 

Manipulatory treatments, according to the best authorities 
writing on massage and Swedish movements, have for their 
object the acceleration of the blood flow on the venous side 
of the general circulation. Osteopathic manipulations are es- 
sentially directed to the active instead of the passive side of 
the circulation. 

The osteopath makes use daily of the vaso-motor nerves 
in order to control the circulation of the blood in local areas ; 
therefore, it is necessary to make a detailed study of this won- 
derful mechanism in order to achieve the best results in prac- 
tice. 

The more we know of structure and function, the more 
rational ought our methods of treatment to be, because we 
will then have no excuse for using methods which do not 
have a scientific basis to recommend them. 

The Heart. — In order to affect the active side of the 
circulation our manipulations must affect the heart beat. 
There are two sets of nerve fibres arising in the cerebro-spinal 
system which exert a regulating influence on the beat of the 
heart. Heart muscle possesses an inherent power of rhyth- 
mical contraction as can be readily proven by removing the 
heart from the body and stimulating it mechanically. It will 
beat rhythmically for hours if the muscle be kept moist with 
a one per cent salt solution. 

Contraction begins in the auricles and ends in the ven- 
tricles ; hence, it is thought that the auricular rhythm is trans- 
mitted to the ventricle. Any influence which changes the 
auricular rhythm also changes the ventricular rhythm. 

Regulation of Contraction. — Since the heart possesses 
inherent power of rhythmic contraction, the nervous system 
acts merely as a regulator of the rate of contraction. The 
two centers of cardiac control act in a manner to increase or 
decrease the rate. The speed of the blood current is depend- 



PRINCIPLES OP OSTEOPATHY. 75 

ent on the rate and strength of the cardiac contractions. The 
pressure of the blood is dependent on the rate and strength 
of the cardiac contractions, together with the resistance offered 
by the arterioles and capillaries. Considering the arterioles 
and capillaries as possessing fixed diameters, an increase in 
the number and strength of the heart beats would increase 
the speed and pressure of the blood current. A lessened car- 
diac activity would have the opposite effect. The speed and 
pressure of the blood stream may vary within wide limits and 
still maintain a fair degree of health. 

Co-ordinating Centers. — The nerve impulses reaching 
the heart are co-ordinated in two governing centers in the 
cerebro-spinal system. These centers are located in the bulb. 
The inhibitory center is connected with cells in the walls of 
the heart by fibres which form a part of the pneumogastric 
nerve. Section of the pneumogastric nerve removes the in- 
hibitory influence over the heart's action. Stimulation of this 
nerve slows the heart. The relaxation period is lengthened 
which results in greater filling of the heart and the pressure 
in the veins is increased while arterial pressure decreases. 
These results have been noted by many physiologists. 

The Pneumogastric Nerve. — The pneumogastric is one 
of the nerve trunks which can be reached by direct pressure 
made through the skin and muscles of the neck. Its inhibi- 
tory action can be aroused by pinching the sterno-cleido- 
mastoid muscle between the thumb and forefinger, taking care 
to work deeply under the internal margin of the muscle. 

It is no uncommon phenomenon to have a patient faint 
as a result of this manipulation. Individuals differ greatly 
as to their response to this stimulation. The stimulation 
should be a gentle pressure of a constantly varying intensity. 

A pulse tracing is appended, Fig. 19, which shows the 
results of stimulating the pneumogastric in the manner just 
described. The gentleman upon whom the experiment was 
made was in excellent health, and possessed a quiet, well- 
balanced temperament. The tracing shows that the number 
and force of the beats was lessened and arterial pressure de- 
creased. This tracing is probably typical of the change, in a 



76 



PRINCIPLES OF OSTEOPATHY. 



well person, in response to stimulation of the pneumogastric. 
No sensation of faintness or other disagreeable feeling was 
noted. 

The inhibitory action of the pneumogastric seems to 
be most active in individuals who suffer from some disorder 
of the digestive tract. In such patients the constant irrita- 
tion of the sensory fibres of the pneumogastric, which arise 
in the mucosa of the digestive viscera, seems to increase the 
irritability of the whole nerve trunk to such a delicate point 
that the slightest stimulation made at any point along the 



i / / Wm / / / / 






pig. 



-Stimulation of the pneumogastric Dy pinching the nerve trunk in the neck. 



course of the nerve will excite its inhibitory action. Many 
osteopaths, just starting in practice, have had their self-pos- 
session severely tried by a patient fainting during manipula- 
tion of the neck. I have never heard of any fatal results 
from manipulation of the pneumogastric. Why stimulation 
of the pneumogastric should result in cardiac inhibition rather 
than in phenomena connected with its other branches seems 
incapable of explanation. Sometimes spasm of the laryngeal 
muscles will accompany cardiac inhibition. 

The intensity of action of the pneumogastrics is so well 
known to experienced osteopaths that they are careful to test 



PRINCIPLES OF OSTEOPATHY. 77 

its irritableness in cases before undertaking any extensive 
manipulations along its course. 

The inhibitory center is continually active, and acts ac- 
cording to the blood pressure within the arteries. A rise in 
peripheral resistance causes a decrease in number and strength 
of the heart beats. 

Accelerator Center. — The accelerator center is con- 
nected with the heart by fibres which descend in the cord to 
the upper portion of the dorsal region ; here connection is 
made with the cells whose fibres pass to the sympathetic spinal 
ganglia, 1st, 2nd, and 3rd dorsal, and end there around other 
cells whose fibres convey their impulses to the heart. 

The action of the accelerator center is not so readily 
demonstrated as is the case with the inhibitory center. It 
causes the heart to beat faster and stronger, thus bringing 
about a rise in arterial blood pressure and a fall in venous 
pressure. This center acts in response to lowered peripheral 
resistance. The products of metabolism brought about by 
physical exercise also excite it. Deep, steady pressure made 
on the muscles lying on each side of the 1st, 2nd and 3rd dorsal 
spines causes a decrease in the rapidity of the heart's action. 



**& <jl *}(**-< 


•n/x 


ilr-*tio-rt *.t /-W; XtU, t 9nS. A. Jtor sfn 


"ti-rr*ttS 


^r^s^j< 


■J? 


^j^jZS^ 


MM 





Fig. 20. — Sphygmograms illustrating the effect of inhibition at the ist, 2nd and 

3rd dorsal. 



Stimulation of the Heart. — A make and break pressure 
made at the edge of the sternum in the ist and 2nd inter- 
costal spaces will usually stimulate the heart. Sometimes the 
first effect is inhibition, but it quickly passes to stimulation. 
The manipulation made anteriorly increases the number and 
intensity of the stimuli reaching the segment of the cord from 



78 , PRINCIPLES OF OSTEOPATHY. 

which the accelerator nerves pass out. All centers act accord- 
ing to the sum of the stimuli reaching them from all sources. 

Inhibition of the Heart. — In cases of rapid heart beat 
with high tension pulse the best effects are secured by digi- 
tal pressure at ist, 2nd and 3rd dorsal spines. The pneu- 
mogastrics have too many branches to important viscera and 
act frequently with unexpected intensity. The accelerators 
act more slowly with less intensity and the action is sus- 
tained longer, that is, as a result of manipulation. 

Vaso-motor Control of the Coronary Arteries. — A fur- 
ther factor in relation to the regulation of the heart's action 
is the blood supply for the nourishment of the heart. All 
organs act with greater force when their blood supply is 
abundant. The heart beats stronger when its coronary arteries 
are dilated than when constricted, therefore the power of the 
heart depends on the vaso-motor control of its own arteries. 
The vaso-motor nerves to the coronary arteries leave the 
cerebro-spinal system between the 3rd and 5th dorsal spines. 
In cases of angina pectoris, this area will be sensitive. Steady 
pressure here will dilate the coronary arteries and ease the 
pain. A sharp stroke with the hypothenar eminence on the 
fourth dorsal spine will nearly always start an attack with 
such patients. 

Angina Pectoris. — Physiologists name the pneumogas- 
tric nerve as the vaso-motor nerve to the coronary arteries. 
I mention the area, 3rd to 5th dorsal, as a vaso-motor center 
for the coronary arteries because clinical experience seems 
to demonstrate it. Other osteopaths have noted the frequency 
of lesions in this area in connection with heart difficulties. The 
lesions are contracted muscles, lateral subluxations of the ver- 
tebrae or in some instances subluxations of the fourth and 
fifth ribs. With any of these lesions there is intense sensi- 
tiveness. 

Dr. George Keith, of Scotland, mentions digital pressure 
in the second left intercostal space as a means of inhibiting 
an attack of angina pectoris, and suggests the nerve connec- 
tion of the pneumogastric as being the nerve path over which 
the inhibitory impulse travels. 



PRINCIPLES OF OSTEOPATHY. 79 

Persons suffering with angina pectoris will press their 
hands, with all the force they possess, against the left chest. 
1 have used heavy digital pressure on the left side of the 
fourth and fifth dorsal spines while the patient was in a 
paroxysm of pain. The pressure never failed to be grateful 
to the patient. A further experiment with this center was 
made by extending the patient in a recumbent position. While 
extension was maintained the angles of the ribs could be 
raised, the left arm could be extended over the head, a full 
inspiration could be taken, but as soon as the vertebrae were 
allowed to approximate as a result of cessation of extension, 
these things could not be done. 

Heat, digital pressure, and counter irritation are capable 
of causing vaso-constrictor paralysis, i. e., vaso dilation, and 
hence increase the power of the heart in such cases. 

Action of the Heart Centers. — The governing centers 
of the heart act principally according to the peripheral resist- 
ance maintained by the blood vessels. The heart possesses 
a nerve called the depressor nerve. Its endings are in the 
walls of the heart and are affected by the pressure of the blood 
within the heart. A rise in arterial pressure is followed by a 
rise in pressure within the heart. The depressor nerve notes 
this fact and carries an inhibitory impulse to the vaso-dilator 
center in the medulla, thus bringing about a fall in arterial 
pressure. In this way the heart is protected from over exer- 
tion as a result of too high pressure. 

In cases having rapid, weak heart action, inhibit the ac- 
celerators to slow the heart, also inhibit in the area of vaso- 
motor control of the coronary arteries to increase the amount 
of blood for nourishment to the heart muscle, thus increasing 
the strength of the beat. 

In cases of rapid, high tension pulse, inhibit the splanch- 
nics and suboccipital fossae to lessen peripheral resistance, also 
inhibit the accelerators or stimulate the pneumogastrics. 

Vaso-motor Nerves. — In 1840 Henle discovered and 
demonstrated the muscular coat of the arteries, and as a result 
of this step forward we have our present knowledge of the 
vaso-motor nerves. Associated with the demonstration of 



So PRINCIPLES OF OSTEOPATHY. 

these nerves, we have the names of Brown-Sequard, Bernard, 
Waller and Scruff. 

It has been proven that two sets of fibres innervate the 
muscles of the arteries ; a vaso-constrictor set, which causes a 
decrease in the calibre ; and a vaso-dilator set which causes 
an increase in calibre. The constrictors were demonstrated 
first. 




^rltiMLj and ^ri/*. 

Fig. 21. — -Drawn by J. E. Stuart, D. O. 

Henle said "the movement of the blood depends on the 
heart, but its distribution depends on the vessels." We have 
followed the phenomena in connection with the first part of 
this quotation, hence it remains for us to study the part 
played by the vessels in the distribution of the blood. 

In order to carry our thoughts along in a proper man- 
ner, we will commence at the center and work toward the 
periphery. 

The chief vaso-motor center is in the medulla. Destruc- 
tion of this center causes an immediate fall of blood pressure 
all over the body. Stimulation of this center causes a general 
rise of blood pressure. 

There are subsidiary centers situated at various levels in 
the spinal cord. 

After the spinal cord is severed, that portion which is no 
longer connected with the chief vaso-motor center will exer- 
cise a vaso-constrictor influence over the blood vessels in its 
area of normal control. "It is probable that they are nor- 
mallv subordinate to the bulbar nerve cells." 



PRINCIPLES OF OSTEOPATHY. 81 

After all connection between the cerebro-spinal system 
and sympathetic spinal ganglia is cut off, the tone of the blood 
vessels is maintained, after a short interval, by the sympathetic 
ganglia. 

By commencing at the center and destroying it, then the 
centers in the spinal cord assume control; destruction of these 
leaves the sympathetic spinal ganglia active; hence by this 
process of exclusion, we find that the true vaso-motor cells are 
sympathetic and lie in the spinal ganglia. From these cells in 
the spinal ganglia axis cylinder processes pass as gray fibres to 
blood vessels. These ganglia cells are controlled by fibres from 
the chief vaso-motor center in the medulla which end around 
the subsidiary cells in the spinal cord, the neuraxons of these 
latter terminating by filaments which surround the true vaso- 
motor cells in the sympathetic spinal ganglia. 

Since gray rami-communicantes pass from the spinal sym- 
pathetic ganglia to the spinal nerves and are distributed with 
them to the skin and blood vessels, we can influence the dis- 
tribution of the blood generally and locally by increasing or 
decreasing the number of sensory impulses, originating in 
the skin and muscle,- which may reach the vaso-motor centers. 

"The vaso-motor apparatus consists, then, of three classes 
of nerve cells. The cell bodies of the first class lie in sympa- 
thetic ganglia, their neuraxons passing directly to the smooth 
muscle in the walls of the vessels ; the second are stimulated 
at different levels in the cerebro-spinal axis, their neuraxons 
passing hence to the sympathetic ganglia by way of spinal and 
cranial nerves ; and the third are placed in the bulb and control 
the second through intraspinal and intracranial paths. The 
nerve cell of the first class lies wholly without the cerebro- 
spinal axis, the third wholly within it, while the second is 
partly within and partly without, and binds together the re- 
maining two." Am. Text-book of Physiology. 

Vaso-constriction. — The vaso-constrictor nerves which 
pass from the bulbar and spinal centers of control leave the 
cord as white rami-communicantes from the anterior roots of 
the second dorsal to the second lumbar nerves and enter the 
sympathetic ganglia to be distributed as has been described 



82 



PRINCIPLES OF OSTEOPATHY. 




F.g. 22. — Vasoconstrictor area, 2nd Dorsal to 2nd Lumbar. 

before. It is believed that all of these vaso-constrictor fibres 
end in the ganglia, thus exerting their influence on the true 
vaso-motor cells in the ganglia which, alone send fibres to 
the blood vessels. All these constrictor nerves are gray. 



PRINCIPLES OF OSTEOPATHY. 



83 



/3t-«.WH/* J «'»«■***■. 



Fig. 23. — Arterial tension is manifested in a sphygmogram by the relative height 
of the aortic notch. The upper tracing shows the aortic notch on 'a straight 
line drawn from the top of one percussion wave to the bottom of the next. 
The middle tracing shows this notch very low. 

Vaso-dilation. — The vaso'dilator fibers are not re- 
stricted to any one portion of the cord or brain, but pass out 
with both cranial and spinal nerves, and do not lose their 
sheaths until they reach their destination. They are best dem- 
onstrated in those regions of the cerebro-spinal system from 
which vaso-constrictors do not arise. The vaso-dilators from 
the head, face, salivary glands, etc., pass to their destination 
with the cranial nerves supplying these parts. They do not 
end in the sympathetics. They probably leave the cord in the 
anterior roots of the spinal nerves and pass to the periphery 
without interruption. The vaso-dilators, leaving the cord in 
the same region as the vaso-constrictors to be distributed to 
the visceral blood vessels probably pass out by the ventral roots 
and reach their destination without losing their sheaths in the 
sympathetic ganglia. 




Fig. 24.- — The significance of a sphygmogram. The space S is the period of ven- 
tricular systole when the aortic halves are open; the space D the period of 
ventricular diastole; t the tidal wave due to the ventricular systole; p the 
percussion wave due to instrumental defect; a is the aortic notch which marks 
the closure of the aortic valves; d the dicrotic wave. 



No distinct centers for vaso-dilator fibres have been dem- 
onstrated. They probably arise from segments of the brain 
and spinal cord and their influence is carried along the paths 
of motor nerves and is exerted in a local area. 



8 4 



PRINCIPLES OF OSTEOPATHY. 



Summary. — i. The vasodilator nerves are cerebro- 
spinal; (a) and are not demedullated in the sympathetic 
ganglia, (b) They are distributed principally to the arteries of 
the muscles; (c) and leave the cerebro-spinal axis with the 
motor nerves from all portions, (d) Their influence is local. 

2. The vaso-constrictors are essentially neuraxons of 
sympathetic cells in the spinal ganglia; (a) are gray fibers; 
(b) are distributed to viscera and cutaneous blood vessels; 



<7<»«Ay«iM-^*«L — Q 



R*H **+ — Grady + m.wJi*L —7^«a^rmi rf«o//fet*\»T» c^JJc-n^ 



Fig. 25. — Sphygmograms illustrating Tachycardia and Bradycardia. Upper tracing 
is from radial pulse of a woman exhibiting great nervousness, a small goitre 
but no exophthalmos. Lower tracing is from radial pulse of a young man 
whose power of recalling past events of his own life was suddenly lost. Result 
of mental shock. 



(c) and are probably continuous in action to maintain the 
tone of the vascular system, (d) The vaso-motor cells in the 
sympathetic ganglia can act independently, (e) but are nor- 
mally under the control of the cells in the spinal cord whose 
neuraxons end in the spinal ganglia, (f) These cells in the 
spinal cord are under the influence of neuraxons of cells in the 
medulla which constitute the chief vaso-motor center, (g) 
Therefore, the vaso-constrictor influence is both local and 
general, (h) The controlling fibres leave the cord in the 
ventral roots of the second dorsal to the second lumbar nerves 
only. 

THE SENSORY NERVES. 

We have now considered in detail only one side of the 
vaso-motor mechanism, the motor. We have yet to note the 
sensory side, that which calls forth the motor response. If 
there were no chief or spinal vaso-motor centers to transfer 
sensory impulses to the vaso-constrictor cells in the spinal 
ganglia, the blood vessels in the viscera and skin, could not 



PRINCIPLES OF OSTEOPATHY. 85 

contract or relax according to the necessity for greater or less 
amounts of heat in the deep or superficial areas. 

The vaso-motor centers in the brain and cord send out 
impulses in response to sensory stimulation ; this sensory stim- 
ulation is usually of a thermal or mechanical character. 

It is difficult to realize the extent of the distribution of 
sensory nerves. "They are located not only in those places 
usually known to be sensitive, but also in all other tissues and 
organs. Whether one examine the liver or the kidney, lung 
or the wall of a blood vessel, one always finds delicate nerve 
arborizations in unsuspected numbers. A large portion of 
them end probably in the peripherally placed end cells belong- 
ing to the reflex arc of the sympathetic ; another portion may 
very probably be traced to the spinal ganglia, and even to 
the spinal cord itself, especially the investigations of the past 
two years, making use of the silver and methyl blue stains, have 
not only disclosed the wealth of nerves in the different or- 
gans, but have also shown that we have regarded the sensory 
innervation of the sensitive surfaces, as the skin, and the 
gustatory-mucous membrane as much less fully explained than 
they really are. One finds there numerous plexuses of nerve 
fibres beneath and between the epithelial cells, and they send 
one, often many fine fibrils to each cell." * * * * "In the 
liver, too, and the bladder, and many other places, one can 
find numerous examples of the abundant peripheral innerva- 
tion. We have always given too great importance to the 
single end apparatus, overlooking the fact that really the major 
portion of the body tissues is supplied with nerves for every 
cell. One can hardly overestimate the wealth of nerve fibres in 
the end organs themselves, as the taste papillae and the tactile 
papillae. Good staining discloses with each of them plexuses 
of unexpected density of arborization." 

"For what services may such an abundant sensory inner- 
vation be provided? It occurs immediately to one that there 
is a great number of reflexes, very necessary to the preserva- 
tion of the individual, even though he be unaware of them. 
The regulation of the secretions, the blood supply to the skin 
in relation to the caloric body economy of the organism, the 



86 PRINCIPLES OF OSTEOPATHY. 

adjustment to varying illumination, the tension of the muscles 
and tendons through the respective tendon reflexes, the dif- 
ferent response by such varying tensions according to the in- 
tensity of the voluntary impulse, and many other phenomena 
could be cited. To all of them is necessary, besides the motor 
part of the reflex arc, a sensory part. Indeed, Exner, to whom 
we are indebted for indicating the importance of these short 
reflex arcs and the roles they play in the organism, has pointed 
out how, in general, for the production of any movement the 
sensory innervation must be intact." 

"By 'sensory innervation,' however, one must not think 
only those processes are meant which enter into our conscious- 
ness, but rather all those by which from any place in the body 
impressions are conducted to the nearest ganglion, or to the 
central axis. Whether they be conducted farther still, or 
whether they be recognized by the individual as they occur does 
not affect their nature. Sensation and perception are not the 
same thing." — Anatomy of the Central Nervous System in 
Man and in Vertebrates in General. — Edinger. 

Thus we find that there are abundant sensory nerves in 
superficial and deep tissue to receive the mechanical stimuli 
which the osteopath may project upon them. 

Recent investigations prove that many conditions which 
have previously been called inflammation are, in reality, con- 
gestions due to vaso-constrictor paralysis, and can be cor- 
rected by stimulation of the vaso-constrictor center govern- 
ing the congested area ; the stimulation of such center being 
secured by mechanical stimuli applied to the sensory nerves 
ending in the center. 

The vaso-motor mechanism responds quickly to osteo- 
pathic manipulation, and is our means of correcting any 
disturbance of circulation both local and general. 

Since the blood carries the nourishment for the tissues, 
and the vaso-motors control the distribution of the blood, the 
vaso-motor nerves are trophic nerves. In the same sense they 
are secretory nerves. 

Capillary Circulation. — The capillary circulation is 
dependent on the state of the arterioles. Their walls are 



PRINCIPLES OF OSTEOPATHY. 87 

formed by endothelial cells which are elastic, and hence re- 
spond to the force of the blood which enters them. If the 
vaso-constrictors are active in a local area the resistance 
offered to the passage of the blood current by the arterioles 
is increased, and therefore the pressure exerted on the capillary 
walls is lessened, allowing the capillaries to contract. If the 
vaso-constrictor influence over the arterioles be lessened, the 
blood current is allowed to exert its pressure on the capillary 
walls, thus increasing the calibre of the capillary. 

If, in a large area of the body, vaso-constrictors are 
active, the influence of this resistance is felt by the heart, 
which immediately beats harder to overcome the resistance to 
the passage of the blood through the constricted arteries. The 
heart is usually relieved by compensatory dilatation of the 
arteries in some other area. The visceral and cutaneous, 
arteries usually counter-balance each other in this way. This, 
counter-balancing effect is probably brought about through the 
sensory impressions sent out from an overworked heart to the 
vaso-motor center, thus causing a lessened constrictor effect in 
some portion of the body. 

The relaxation of all the arteries of the body would cause 
death, because the blood would gravitate to the most de- 
pendent part, and there is not blood enough to fill all the 
arteries when relaxed. A slight relaxation of general blood 
pressure causes the heart to beat more rapidly for a short 
time. Relaxation of the peripheral blood vessels is noted by 
the increased warmth and redness of the area in which relaxa- 
tion takes place. 

Recapitulation. — To recapitulate: (1) Capillary circu- 
lation is passive. (2) Vaso- constriction of the arterioles 
causes a decrease in the lumen of the capillary. (3) Vasodi- 
lation of the arterioles causes increase in the lumen of the 
capillary. (4) General vaso-constriction of the cutaneous 
blood vessels slows the heart and causes it to work against 
higher pressure, but the heart is relieved by relaxation of blood 
vessels in visceral areas, chiefly the splanchnics. (5) De- 
crease of constrictor effect on superficial vessels causes a more 
rapid heart beat, which is quickly controlled by constriction 



88 PRINCIPLES OF OSTEOPATHY. 

in the splanchnic area. (6) The vaso-motor center in the 
medulla acts according to the sum of the sensory influences 
reaching it from all parts of the body. (7) The spinal vaso- 
motor centers act according to the influences sent to them by 
the chief center and the sensory impulses which enter their 
segment of the cord. 

Vaso-motor Centers. — The vaso-motor centers for the 
various viscera, organs and members are as follows : 

HEAD : The superior cervical ganglion. 

EYE : The superior cervical ganglion through the fifth 
nerve. 

NOSE, THROAT, TONSILS, TONGUE and GUMS : 
By the same path. Dilator fibres for the tongue per the lin- 
gual branch of the fifth cranial nerve. 

BRAIN : ''Sherrington and others have demonstrated 
the presence of vaso-motor nerves in the vessels of the brain. 
It is probable that the cerebral circulation is wholly de- 
pendent upon the general blood pressure, and, inasmuch as 
the general blood pressure is very markedly regulated by 
the capacious splanchnic area, it is obvious that the cerebral 
circulation may be better controlled by modifying the blood 
supply of the splanchnic area than by any attempts at the modi- 
fication of the cerebral circulation itself." 

Sympathetic fibres to the anterior and middle fossae 
come from the superior cervical ganglion per the carotid 
plexus. Sympathetic fibres are distributed to the vessels in 
the posterior fossa from the vertebral plexus which is formed 
by fibres from the inferior cervical ganglion. 

THYROID GLAND: Middle and inferior cervical 
ganglion. 

The vaso-constrictors for the blood vessels of the head, 
face and neck with their contained organs leave the spinal 
cord in the upper dorsal, second to fifth, and pass thence 
through the cervical ganglion. 

LUNGS : Second to the sixth dorsal. 

INTESTINES : The vaso-constrictors for the mesen- 
teric blood vessels are found in the splanchnic nerves. Com- 
mencing at the fifth dorsal, there is a segmental distribution 



PRINCIPLES OF OSTEOPATHY. 89 

to the various portions of the intestines. The lowest constrictor 
influence comes from the second lumbar. Vaso-dilator fibres 
are also found in the splanchnics. 

LIVER : Sixth to tenth dorsal, right side. 

KIDNEY : Tenth to twelfth dorsal. 

SPLEEN: Ninth, tenth and eleventh dorsal, left side. 
The vagus is a motor nerve to the muscular fibres in the 
trabeculae of the spleen. 

PORTAL SYSTEM : Fifth to ninth dorsal. 

EXTERNAL GENERATIVE ORGANS: First and 
second lumbar, through the lumbar sympathetic ganglia, sec- 
ond to the fifth, to the hypogastric plexus, thence through 
the pelvic plexuses and pudic nerves to the generative organs. 
Function, vaso-constriction. First, second and third sacral 
nerves are vaso-dilators to the same organs. 

INTERNAL GENERATIVE ORGANS : Vasocon- 
strictor influence at first and second lumbar. 

ARTERIES TO THE SKIN OF THE BACK: Vaso- 
constrictor influence from sympathetic ganglion of the corre- 
sponding segment. 

UPPER EXTREMITY: Vaso-constrictor influence to 
the skin, from second to the seventh dorsal. 

LOWER EXTREMITY: Sixth dorsal to second lum- 
bar. 

MUSCLES: Dilator influence to the arteries of the 
muscles per motor nerves to the muscles. 

Conclusions. — Vaso-motor nerves are of two classes, 
viz : Vaso-constrictor and vaso-dilator. These nerves act 
according to the sum of the stimuli reaching their governing 
center over sensory nerves of skin, muscle and gland. There- 
fore the osteopath depends on increasing or decreasing the 
stimuli reaching the spinal centers. 

The heart is innervated by two sets of nerves which con- 
trol it. These nerves arise from centers in the cerebro-spinal 
system and govern the action of the heart according to the 
sum of the stimuli reaching their centers over sensory nerves 
of skin, muscle and gland, and in harmony with the resistance 
maintained by the peripheral blood vessels. 



9© PRINCIPLES OF OSTEOPATHY. 

Since perivascular tissues are dependent on the trans- 
fusion of nutriment from the blood, through the walls of the 
capillaries into the lymph, and this process of transfusion is 
dependent on the tension and speed of the current of blood 
in the capillaries, any condition which markedly increases or 
decreases this speed and tension will affect the nourishment 
of the tissues. 

Pathology. — Our pathology is largely a study of hy- 
peraemic and ischaemic conditions. Our methods of diagnosis 
ferret out these conditions quickly, and our therapeutics are 
planned to control them by purely scientific methods, i. e., 
by means of the nerves governing heart action and arterial 
tension. Where passive circulatory disturbances exist, atten- 
tion is paid to the venous side of the circulatory apparatus. 

Hyperaemia is probably the most prevalent disturbance 
of the circulation with which we come in contact. Such a 
condition as this is a predisposing factor in the establish- 
ment of bacterial inflammation. The hyperaemia weakens 
the resistance of the tissues in which it exists, thus furnish- 
ing the proper conditions for bacterial infection with result- 
ing inflammation. 

A study of hyperaemia is, in reality, a study of the vaso- 
motor mechanism. We have noted the fact of vaso-motor 
nerves controlling the calibre of blood vessels. These nerves 
are branches of the cerebro-spinal system. Most of them 
leave the spinal nerves and pass to the sympathetic spinal 
ganglia as rami-communicantes and then pass up and down 
to other ganglia of the sympathetic system. Some fibres re- 
turn from the sympathetic to the spinal nerves and are dis- 
tributed to blood vessels of skin, muscle and bone in the area of 
distribution of the spinal nerves. A few vaso-motor nerves do 
not enter the sympathetic system but pass directly to their 
destination with the spinal nerves. Thus two paths exist by 
which vaso-motor impulses reacr? the blood vessels, a direct 
route with the spinal nerves and an indirect one through the 
sympathetics. 

Experimenters have long noted the return of vascular 
tone in an area whose vaso-constrictor nerves have been cut. 



PRINCIPLES OF OSTEOPATHY. 91 

This return of vascular tonicity is supposed to be due to the 
presence of a perivascular mechanism which is capable of 
acting feebly after all other constrictor influences have been 
paralyzed. 

So far as methods of treatment are concerned, we have 
paid very little attention to the presence of vaso-dilator nerves, 
but physiologists seem to prove that there are fibres leaving 
the cord with the posterior roots of the nerve trunks which 
act as dilators when irritated. The vaso-constrictor nerves are 
considered as constantly in action. 

Irritation of the dilator nerves or paralysis of the con- 
strictors will result in dilatation of the arterioles, so that the 
capillaries will be dilated to their fullest extent. Such a con- 
dition is called an "active hyperaemia." When the exit of 
the blood through the veins is obstructed and congestion re- 
sults it is denoted "passive hyperaemia/' 

Acute or chronic hyperaemias as we note them in os- 
teopathic practice, are usually originated by mechanical le- 
sions, i. e., bony displacements which are either the result of 
accident, and hence primary lesions, or due to the unequal 
contraction of the attached muscles, and hence secondary 
lesions. 

These bony and mus*cular lesions may also be the result 
of congestion in the mucosa of the intestines caused by the 
presence of indigestible substances. 

The same irritants, mechanical, thermal and chemical, 
which are capable of stimulating muscles to unusual or unequal 
contractions so as to produce marked evidences of changed 
bony alignment, also cause such decided changes in the calibre 
of blood vessels as to cause tissues to become hyperaemic or 
ischaemic. 

The majority of cases seen by the osteopaths are chronic, 
and the hyperaemic condition has been developed by slow 
degrees. Some slight but persistent lesion which shows itself 
to palpation will be found to be the cause. 

If any hyperaemia exists in the mucosa of the stomach, 
palpation around the sixth dorsal spine will disclose tender- 
ness. This spinal tenderness is probably due either to the 



92 PRINCIPLES OF OSTEOPATHY. 

irritation of the dilator fibres which accompany the posterior 
division of the fifth dorsal nerve or to paralysis of the vaso- 
constrictors of that area. The resulting dilatation impinges 
on sensory nerves and causes tenderness. The irritation of 
sensory nerves in the mucosa of the stomach causes dilata- 
tion of blood vessels in that area and in the spinal area from 
which its sensory nerves arise. The irritation might have 
originated centrally and then involved the stomach, thus re- 
versing the course of the irritation. These reflex hyperaemias 
are continually noted in practice, and it is through the re- 
flexes that relief is obtained. One of the classical experiments 
to prove the reflex action of vaso-motor nerves is to immerse 
one hand in cold water, the temperature of the other hand will 
be lowered also. 

It is quite generally conceded that the small arteries and 
arterioles in all parts of the body are supplied with vaso-motor 
nerves. Their presence in the blood vessels of the brain has 
been recently proven by G. C. Huber. His demonstration of 
vaso-motor nerves in the cerebral blood vessels explains many 
of the circulatory phenomena resulting from osteopathic 
manipulations. 

Irritation of sensory nerves in any part of the body causes 
vascular dilatation in the irritated area. Physiological ex- 
periments seem to prove that vaso-dilator fibres accompany 
the sensory nerves, or that irritation of sensory nerves causes 
paralysis of vaso-constrictor nerves. Irritation of the nerves 
of one side of the body by pricking with a pin causes a rise 
of temperature on that side and a decrease on the unirritated 
side, thus demonstrating that vaso-dilation follows sensory 
irritation. 

Experiments to note the effects of direct mechanical 
irritation of the stomach mucosa demonstrate that dilatation 
of gastric blood vessels follows mechanical irritation. The 
physiological hyperaemia thus produced is for purposes of 
increased secretion. It is well known that when this physio- 
logical congestion is continued without cessation as in the case 
when meals are frequent and full, the congestion becomes 
pathological, and the secretion of mucus is rapid. The liver 



PRINCIPLES OF OSTEOPATHY. 9 3 

and intestines become chronically congested from similar 
causes. This hyperaemia leads to exudates and hyperplasia 
which further irritates sensory nerve endings and continues 
the dilatation of the arterioles. Thus a vicious cycle of 
reflexes is established which tends to ever increasing de- 
structiveness. 

When the sensory nerve terminals in the stomach are irri- 
tated and hyperaemia of the gastric vessels results, the in- 
fluence of the irritation does not end with gastric congestion, 
i. e., if the hyperaemia be excessive, but causes dilatation of 
arteries in the spinal cord around the roots of sensory nerves 
distributed in other parts of the body which are supplied by 
branches of the same nerve trunk. The brain does not always 
note the real location of the irritation. It may refer the pain 
to any point supplied by a branch of the nerve trunk, one 
of whose branches is irritated. Thus in the presence of 
chronic congestion of the gastric mucosa, as in gastric ca- 
tarrh, the irritation may not be intense enough to impress the 
brain with a painful sensation, but a slight increase of capillary 
pressure around the trunk of the sixth dorsal nerve such as 
would be brought about by digital pressure made upon the 
muscles around the sixth dorsal spine, would cause instant 
recognition of hyperaesthesia by the patient. Continued 
pressure made around the spine drives the blood out and les- 
sens the sensitiveness. If hyperaemia has been intense enough 
to cause exudates, pressure increases the pain the longer it 
is continued, because the exudates have aiTected the venous 
circulation and there is no open path for exit of the blood. 

From personal experience I should judge that it is quite 
probably that hyperaemia occurs along the whole course of the 
nerve and the nervi nervorum are rendered more sensitive 
thereby. In case of absolute neuritis, manipulation relieves the 
condition temporarily, but the pain increases shortly after the 
treatment is given. This shows that a condition exists which 
is much more difficult to change than a reflex hyperaemia. 

Continued hyperaemic conditions cause increased nutri- 
tion, i. e., hyperplasia of connective tissue. Connective tissue 
seems to be more readilv formed than anv of the higher grades 



94 PRINCIPLES OF OSTEOPATHY. 

of tissue. This may explain the rapid stiffening of the spine 
in cases of visceral hyperaemia. 

The digital pressure test is an excellent method of dif- 
ferentiating the intensity of an hyperaemia. Even in cases 
of conscious pain in the gastric or intestinal areas, it is pos- 
sible to use this test. In colic, deep pressure made gradually 
will give relief, but in cases of gastric ulcer or other inflam- 
matory conditions, pressure aggravates the pain. 

Therapeutics. — We now have before us an array of 
physiological facts and it remains for us to indicate how we 
shall use them. 

The osteopath treats the vaso-motor nerves as though 
there were no dilator fibres to be reckoned with. Practically 
we consider that the vaso-constrictors are continually acting 
to maintain the "tone" of the blood vessels. Therefore, having 
only this one force with which to reckon, we consider all dila- 
tation as vaso-constrictor paralysis. 

We noted the fact that the cutaneous and visceral blood 
vessels were supplied with vaso-constrictors and that vaso- 
constriction in the superficial area was compensated for by 
dilatation in the deep area. 

A large number of sensory impressions reaching the vaso- 
motor centers over the sensory nerves of the skin usually re- 
sult in vaso-constriction of cutaneous blood vessels, hence in- 
ternal congestion. Irritation of the sensory nerves in the skin 
may cause muscle under the skin to contract, thus obstructing 
the circulation in the skin. Therefore, our manipulations for 
vaso-motor effects naturally divine themselves into two classes : 
First, those which inhibit cutaneous reflexes ; second, those 
which relax muscle in order to remove obstructions. This 
division is purely arbitrary /on our part, but it serves to ex- 
plain our work. We purposely leave out of this discussion 
the thought that we may have an osseous lesion causing our 
vaso-motor disturbance. We divide the spine into areas ac- 
cording to the predominating influence which issues from it, 
thus, the sub-occipital fossa is the first important area. It has 
long been know that pressure applied to this area in a case of 
congestive headache gives great relief. The good effects are 



PRINCIPLES OF OSTEOPATHY. 95 



I not lost when the pressure is removed. This proves that the 
effect of the pressure is on the nerves of that area, and that 
they are in close central connection with the vaso-motor cen- 
ter in the medulla. This center regulates the calibre of the 
arteries all over the body. It has been stated that pressure 
at the basi-occiput retards the blood flow to the brain, the 
pressure being on the vertebral arteries. We believe a care- 
ful examination of the atlas will convince one that in the 
average skeleton the groove for the vertebral artery is so deep 
and well protected that pressure on the surface of the neck 
cannot affect the artery. If our pressure effect is mechanical, 
why does the effect last so long? The blood stream is as 
swift as an ocean greyhound, and would rush into the partly 
filled vessel with its previous force, just the moment the 
pressure is removed. We can only explain the result by 
noting the fact that a change has been made in the entire cir- 
culation. Downward pressure on the carotids is also recom- 
mended to retard the blood flow to the head. This seems im- 
practicable since the pressure cannot help affecting the venous 
return as well as the carotid stream. The best and most last- 
ing effects are always vaso-motor. 

It is a well recognized fact in the osteopathic profession 
that pressure in the suboccipital triangles causes a lessened 
blood pressure all over the body. This fact is made use of 
daily to lower the temperature of the body in cases of fever. 
If pressure had a mechanical rather than a nervous effect on 
the circulation, we could hope for no general effect, such as we 
do secure. This procedure is called inhibiting the vaso-motor 
center. Why does it inhibit? A "vascular tone" is normal 
in the body in order to keep the blood equally distributed. 
This "vascular tone" is easily disturbed since it acts according 
to the sum of the sensory impulses reaching the center in 
the medulla. Pressure in the suboccipital triangles affects not 
only the sum of the stimuli reaching the center, but, most im- 
portant of all, affects the capillary circulation in this area 
which is in close nervous and circulatory connection with the 
medulla. Any external application, such as hot or cold water, 
local anaesthetics or counter-irritants must secure whatever 



96 PRINCIPLES OF OSTEOPATHY. 

internal change may be manifested, by the effect these thera- 
peutic procedures may have on cutaneous nerves. 

Pressure in the sub-occipital triangles will relax the struc- 
tures forming those triangles, thus lessening the sensory im- 
pulses entering the center from that source. The relaxed 
structures will hold more blood, hence they will in a slight 
degree relieve congestion of the center. 

These triangles are the bilateral surface centers in which 
we operate to cause dilatation of vessels in the skin of the 
trunk and extremities. We inhibit vaso- constriction of sur- 
face arteries. 

The next great constrictor area is the splanchnic, sixth 
to eleventh dorsal. This and the preceding area are the two 
points of vantage for the osteopath. Since the splanchnic 
nerves control a system of blood vessels whose combined ca- 
pacity is equal to the entire amount of the blood in the body, 
we can quickly realize what it means to the general circula- 
tion to affect this area. In all cases of congestive headaches, 
fever, hyperaemia of visceral organs, etc., we "inhibit the 
splanchnics." Why? The reflexes between the skin of the 
back and the muscles of the back are so intense that they cause 
vascular constriction of the cutaneous arteries and contraction 
of the deep muscles of the back, thus adding a mechanical 
obstruction to the circulation of the blood in an already con- 
stricted area. Is it not possible, yea, probable, that this state 
of the surface tissue causes a congestion of the vaso-motor 
centers in the dorsal area of the cord, thus nullifying their con- 
trol of the splanchnic area ? Such a condition might be brought 
about by cold. The eating of indigestible food which remains 
a long time in the digestive tract may also be a cause. 

The facts are as we have stated them, we inhibit over the 
splanchnic area to lessen the intensity of the reflexes in that 
area, thereby allowing the centers to regain their control. 
Remember that inhibition lessens the sensory impressions 
reaching a center and relaxes muscle both directly and indi- 
rectly. 

Case Illustrations. — An illustration of osteopathic 
methods applied to hyperaemia is afforded by the following 



PRINCIPLES OP OSTEOPATHY. 97 

case : A gentleman about fifty years of age was inspecting 
mines in the vicinity of Yuma, Arizona. He was of plethoric 
habit and hence the heat of that locality affected him quickly. 
About eight P. M., while in his tent preparing to bathe in 
order to get some relief from the intense heat, he felt a wave 
of weakness pass up his left side and almost instantly power 
of motion on that side was lost. Paralysis did not extend to 
the face. The gentleman was brought to Los Angeles and 
came under the best of medical treatment. Electricity and 
massage were tried with fair success, but the left arm and 
hand remained helpless and were carried in a sling. The hand 
was badly swollen and would pit under pressure, thus showing 
a marked degree of vaso-constrictor paralysis. The hand and 
arm had been thoroughly massaged for two months before 
osteopathic treatment was given. One hour's seance with the 
masseur would make a wonderful change in the hand, but 
the oedematous condition returned in a few hours. The fingers 
were bent into the palm, showing a marked tendency to a 
spastic condition. 

From the medical standpoint it was considered sufficient 
for this case to have the local massage of the arm and hand, 
with administration of strychnine. 

The osteopathic examination was made at the end of two 
months of the treatment just outlined. Slight signs of paraly- 
sis were noted at the angle of the mouth on the hemiplegic 
side. Examination of the neck showed marked contraction of 
the deep cervical muscles on the left side, extending from the 
occiput to the fourth cervical vertebra. Moderate digital pres- 
sure over these contracted muscles caused pain. There was 
also some tenderness as low as the sixth dorsal spine. The 
intense contraction and tenderness in the upper cervical region 
was noted as a secondary lesion existing as a result of a blood 
clot. It was reasoned that if these contracted muscles could 
be relaxed cerebral circulation would be equalized and more 
rapid absorption of the clot made possible. The spinal tender- 
ness was brought about by the same law of irritation of sen- 
sory nerves we have previously stated. There was a dilated 
condition of the arterioles around the roots of the sensorv 



98 PRINCIPLES OF OSTEOPATHY. 

nerves in the cord similar in character to that which existed at 
the peripheral distribution of these nerves, especially in the 
hand. There was decided wrist and elbow reflex, showing that 
the subsidiary nerve cells in the cord were intact, but that either 
the cerebral motor areas or some part of their connecting paths 
were injured. The vascular tone of blood vessels in all other 
parts of the body was good, showing that the chief vaso-motor 
center in the medulla was acting. Here was a case showing 
a perfect reflex in the arm but loss of ability to will a mo- 
tion; perfect sensation and vaso-motor paralysis. 

Treatment was directed to securing relaxation of the con- 
tracted cervical muscles and to break up adhesions in the 
shoulder joint which had been allowed to stiffen. No treat- 
ment was given to the hand or arm. The patient was in- 
structed to straighten the bent fingers with the well hand many 
times per day to overcome the spastic condition. Vaso-motor 
tone returned to the blood vessels of the hand in proportion 
to the amount of cervical relaxation accomplished. At the end 
of one month the hand was allowed to hang naturally, and 
scarcely any oedema was noticeable. Muscular control and 
power have steadily increased. 

Another illustration is afforded by the following case : A 
gentleman suffering with inflammatory rheumatism in the 
second toe of the right foot sought relief by means of osteo- 
pathic treatment. He had used the salicylates in his previous 
attacks, but his stomach had become intolerant of them. The 
toe was red and angry looking, throbbing with pain and 
swollen to the size of the great toe. 

Examination of the spine revealed tenderness between the 
fifth lumbar and third sacral spines, also between the second 
and third lumbar spines. Why should tenderness exist at 
these points ? The answer according to anatomy and physiol- 
ogy is that these spinal areas mark the point of emergence 
from the spinal column of the anterior crural and great sciatic 
nerves which are distributed to equal parts of the affected toe. 
The sensory nerves being irritated by the deposit of faulty 
katabolic products in the tissues of the toe as the result of a 
slow blood stream. In this case the patient was caught out 



PRINCIPLES OF OSTEOPATHY. 99 

in the rain and got his feet wet. The peripheral irritation 
of the sensory nerves caused dilatation of the arterioles and 
capillaries. The blood vessels around the roots of other sen- 
sory nerves which were branches of the same nerve trunks 
also dilated in response to this irritation, i. e., hyperaemia in 
the spinal cord was brought about at the point of origin of 
the anterior crural and great sciatic nerves, hence the sensory 
nerves to the skin and muscles of the back which are innervated 
from the same area of the cord as these great nerve trunks 
will also be tender to increased tension such as that secured by 
the digital pressure. 

In a case such as this we do not desire to have the deposit 
in the toe taken up until the eliminating organs of the body 
are acting freely. To force it into the circulation before such 
time as it can be eliminated may result in inflaming another 
part. It is quite necessary that the throbbing pain be subdued 
so that sleep may be had. The patient soon learns to take ad- 
vantage of venous circulation by elevating the foot. If pres- 
sure upon and a gentle relaxing movement of the muscles in 
the spinal area is made, there will quickly be noted a decrease 
in spinal sensitiveness followed by lessened conscious pain in 
the toe. It is quite probable that pain in the toe is due to 
hyperaemia ; sensitiveness in the spinal area is due to the same 
sort of condition, the difference being in degree. It is impos- 
sible to prove the presence of these transitory hyperaemias by 
any direct observations any more than it is possible to prove 
by post mortem examination that hyperaemia or anaemia of 
the brain is present as a fixed pathological lesion in faulty func- 
tioning of the brain. 

Pressure and relaxation in the spinal area draws the blood 
away from its position around the nerve trunk roots and thus 
stops many of the impulses which would originate centrally as 
a result of the irritation of sensory roots of the nerve trunk. 

We usually think of these reflex sensitive areas of the 
spine as being evidence of the ability of all the branches of 
a nerve trunk to express some degree of the irritation being 
brought to bear on any one of the branches. It seems to me 
that in the light of what is known to happen in the area of 



LofC. 



ioo PRINCIPLES OF OSTEOPATHY. 

an irritated nerve, hyperaemia, that the same change in cir- 
culation may occur around the roots' of its parent nerve trunk 
and he the sole reason for what we denominate a reflex pain. 
By giving the heavy movement required to replace a sub- 
luxated vertebra or even to relax tense muscles around an 
otherwise normal articulation, it is quite probable that inex- 
plicable changes are wrought in the circulation at these points 
which immediately changes the character of the nerve impulses 
originating or reflexing from this portion of the spinal cord. 



CHAPTER V. 



SECRETORY TISSUE. 

Metabolism. — One of the attributes of the primitive 
cell is metabolism. We find it exemplified in the activity of 
those epithelial cells which are known under the general clas- 
sification of secretory tissues. When studied under the micro- 
scope their protoplasm exhibits definite changes. The cell may 
not show any decided change in form, but the protoplasm 
manifests a change in its molecular composition. 

The terms "gland"' and "secretion" are very indefinite. Since 
it is possible that all tissues may give oft* secretions which are in 
some degree comparable to those discharged into the blood 
by the thyroid or adrenals, it is evident that the designation 
of secretory tissue as the representative of cell metabolism 
may be far short of the actual facts. However, the metabolism 
in secretory cells of glands which discharge their secretion 
on the surface can be readily studied. The knowledge of 
metabolic processes in the ductless glands is arrived at mainly 
by deduction. 

Epithelium. — By right of age and extent of distribu- 
tion secretory tissues should have held first place in this series 
of chapters on the Principles of Osteopathy. Secretory cells 



PRINCIPLES OF OSTEOPATHY. 101 

are epithelial. Epithelial cells are the oldest in the body. 
There are animals which have no other kind of tissue. The 
first stages in the development of our own bodies are marked 
by the presence of two layers of epithelial tissue, the ectoderm 
and endoderm. Less histological change has occurred in 
epithelial cells than in any other tissues of the body. In other 
tissues we find the original form of the cells almost or com- 
pletely lost. It has become subordinate to the functional activ- 
ity of that which its activity has secreted. For example, we 
note the development of a muscle fiber. The original cell 
secretes "specific muscle substance" upon its surface. Just 
in proportion to the functional activity of the "specific mus- 
cle substance" do we find the original cell structure subordin- 
ate. Plain muscle fibers show merely a change in the form of 
the original cell. No striations have been formed. Heart 
muscle cells have secreted more "specific muscle substance" 
arranged in fibers, the nucleus and protoplasm have been 
crowded to one side by the structure which they have created. 
The completely striated muscle almost entirely supplants that 
which created it. Its nucleus and surrounding protoplasm 
are obscured. 

We have noted how the original cells of our bodies have 
gradually surrendered various activities which the parent cell 
possessed. For each one to have retained all these character- 
istics would have resulted in mere bulk of tissue and each 
cell would have hindered the others. The differing products 
of protoplasmic activity have resulted in a specialization of 
tissues which makes for harmony and completeness. 




Fig. 26. — Stratified squamous epithelium from human mouth. 
Drawn by A. M. Hewitt. 

Protective Epithelium. — As before mentioned, epi- 
thelial cells show less histological change than other tissue 
cells. The original embryonal layers were epithelial, both 



102 



PRINCIPLES OF OSTEOPATHY. 



layers having an external surface. The epithelial cells form 
a protective covering, the skin. We find them forming the 
lining of the respiratory, digestive and renal tracts. In all 
these situations probably the first duty is protection. Removal 
of epithelium results in inflammation which continues until re- 
generation occurs. Destruction of considerable areas of epi- 
thelium, as by burns, may expose so many nerve endings that 
death results. Thinness of this covering has given rise to the 
expression, "her nerves are very near the surface," meaning 
that the nerves are easily stimulated. 




Fig. 27. — Ciliated columnar epithelium, vas epididymis. 
Drawn by J. E. Stuart, D. O. 



Secretory Epithelium. — The position of epithelium on 
the surfaces of the body compels it to serve other purposes 
than protection. The katabolic products from the deep tissues 
must be passed to the surface and cast off by the epithelial 
cells, likewise all anabolic material for the life and growth 
of internal cells must be taken up by these surface cells. 
Most of the food material needs to be dissolved and chemically 
changed before being fit for the use of internal cells, there- 
fore certain cells throw out protoplasmic products which bring 
about the proper changes in the food materials. As a result 
of these various duties performed by epithelial cells we have 
the words "excretory" and "secretory" both coming under the 
general head glandular epithelia, or as we have entitled this 
chapter, secretory tissue. 

Sensory Epithelium. — . A third duty of epithelial tis- 
sues is to receive impressions from the outside world, and 
stimulate sensation. The functions of seeing, hearing, tast- 



PRINCIPLES OF OSTEOPATHY. 



103 



ing, smelling and touching are dependent on special arrange- 
ments of epithelial cells called sensory epithelia. 




Fig. 28. — Section of ileum of a cat showing glandular epithelia. 
Drawn by A. M. Hewitt. 



Gland Formation. — The simplest arrangement of 
glandular epithelium is found where "gland cells" are scat- 




%fft? 



^ei4^^f^>l%^Wii 




Fig. 29. — Retina of a cat's eye showing sensory epithelia. Drawn by A. M. Hewitt. 

tered here and there among the ordinary epithelial. For ex- 
ample, the goblet cells found in the mucous membrane. The 



104 PRINCIPLES OF OSTEOPATHY. 

protoplasm of these goblet cells produces the slimy substance 
known as "mucus." The mucus is accumulated within the cell 
capsule until the tension becomes so great that the capsule 
breaks and the protoplasmic product is discharged upon the 
surface of the membrane. When the cells of protective epi- 
thelium are sufficiently interspersed with gland cells it is 
called a glandular membrane. A vertical section of such a 
membrane shows the "goblet cells" crowded away from the 
surface but a slender prolongation gives them access to it. 
When many glandular cells are collected together, invagination 
occurs, thus increasing the extent of surface. Such a forma- 
tion is called a multicellular gland. This method of invagina- 
tion may cease in its simple tubular form, or proceed to the 
formation of extensive organs like the salivary glands, pan- 
creas or liver. 

Sexual Cells. — The sexual cells are found among epi- 
thelial cells. Since epithelial tissue is the oldest and the least 
changed, it is not surprising that sexual cells should be found 
generated in relation with this form of tissue. Sexual cells 
tend to form invaginations similar to those formed by glandu- 
lar cells, hence the use of the term sexual glands. 

Summary. — Since we find that epithelial tissue acts as 
a protection to all other tissues, that excretion and secretion 
are carried on by it, that some cells are so highly specialized 
that our special senses are dependent upon them, we realize 
how extensively we depend upon the integrity of this tissue. 
Its position at once places it in relation with external stimuli 
and internal activity. It is most closely associated with the 
central nervous system, therefore we can expect to secure far- 
reaching results by bringing our therapeutic methods to bear 
on this surface tissue. 

Arrangement of Gland Cells. — We will consider only 
those glands which give off an external secretion. They con- 
sist of epithelial cells arranged with definite relations to a base- 
ment membrane, on the other side of which is placed a net 
work of blood, vessels. The secretion is selected from the 
lymph which bathes the cells, and is poured out on the free 
surface. 



PRINCIPLES OF OSTEOPATHY. 105 

All glands have the general structure just described but 
are oftentimes complicated in arrangement to suit the special 
function required. Just as the arrangement of glands varies, 
their secretions also vary. 

Filtration, Osmosis and Diffusion. — If we go back to 
the early study of secretory tissues we find the investigators 
describing secretion as a process of filtration, osmosis or dif- 
fusion. The basement membrane was supposed to affect the 
liquids passing through it. the differences in its intricate struc- 
ture accounting for the differences in the various secretions. 
The explanations of all physiological processes have been at 
one time expounded on a purely physical basis. Text 
books of ten years ago had very little to say in support of 
selective power of secretory cells. They were given an entirely 
passive roll. Our modern text books lay great stress on the 
part played by individual cells in the production of the 
characteristic secretions of definite glands. Close study of 
nerve endings when stained by the golgi method has re- 
vealed the wealth of nerve arborizations around epithelial cells. 
Thus it is noted that each cell is an important active unit in 
the work of the gland and that its perfect work is necessary 
for the successful action of the gland as a whole. Without 
our knowledge of this intimate connection between individual 
cells and the nervous system it would be hard to comprehend 
the physiological action of glands. So long as our knowledge 
took cognizance only of the general relation of cell to base- 
ment membrane and blood supply it was thought that the phe- 
nomena of filtration, osmosis and diffusion were sufficient ex- 
planation. If this were all, then vaso-motion, which regu- 
lates blood pressure, would be the mechanism by which secre- 
tion is controlled. 

The Individual Cell. — Physiologists had observed 
phenomena which were not explainable by the methods just 
mentioned. The pressures in the blood and secretions did not 
bear the proper relations to each other, in fact they were re- 
versed, this necessitated a complete reconstruction of theories 
in regard to secretion. The individual cell now takes its po- 
sition as a vital factor in the activity of the gland and it acts, 



106 PRINCIPLES OF OSTEOPATHY. 

not according to blood pressure on the hither side of its base- 
ment membrane, but according to the governing impulse which 
reaches it over a nerve fiber which proceeds from a center of 
control. This center of normal control acts according to the 
sum of the stimuli reaching it from other centers. 

Secretory Fibers. — It is practically impossible to de- 
monstrate the presence of secretory fibers to all glands. It 
is difficult to separate the vaso-motor and secretory fibers 
even in those glands where the dual action is best demon- 
strated. Since true secretory fibers are known to exist in 
a few cases, physiologists are not slow to concede the proba- 
bility that they are present in all cases. 

The microscope is able to demonstrate the direct partici- 
pation of certain epithelial cells in the formation of the se- 
cretion from certain glands. The goblet cells can be studied 
as they discharge their mucous on the surface, likewise the 
cells in sebaceous and mammary glands. 

It is quite probable that not only the organic constituents 
of the secretions, but the amount of water and salts also are 
under the control of secretory nerves. For the experiments 
upon which these statements are based any of the recent 
physiological text books will furnish the data. 

The New View-point. — The students of ten years ago 
who studied carefully the phenomena of diffusion, osmosis or 
filtration find now very little emphasis placed upon these 
physical explanations of the phenomena of respiration, ab- 
sorption or secretion. A new physiological view-point has 
been formed which gives to the individual cells an import- 
ance hitherto ignored, and likewise gives us understanding of 
the far-reaching control of the nervous system, which makes 
us conscious of the fact that we are not a collection of me- 
chanical devices exemplifying physical laws but a co-ordi- 
nated mechanism, essentially vital, acting according to psy- 
chical as well as mechanical, thermal and chemical stimuli. 

When we have thoroughly incorporated in our minds 
the fact that the phenomena manifested in the manifold activi- 
ties of our bodies have a vital and a physical side we are 
prepared to study physiology without losing our balance be- 



PRINCIPLES OF OSTEOPATHY. 107 

cause of fixing our attention too much on one side or the 
other. 

Necessary Conditions for Secretion. — Every gland re- 
quires four conditions for its proper activity ; ( 1 ) proper 
structure, i. e., it must have inherited normal power; (2) 
unimpeded blood supply; (3) the normal elements of its se- 
cretion must be in its blood supply; (4) perfect nerve con- 
trol. 

As physicians we view every perversion of secretory tissue 
in the light of these four requisites for perfect action. 

If the first condition exists we can do nothing toward 
remedying the deficiency but in some cases we can supply a 
substitute for the normal secretion of the defective glands. 
Sebaceous glands are frequently lacking and hence the skin 
is dry and harsh. It is the duty of the physician to supply 
a substitute for the product of these glands. 

Classes of Drugs Which Affect Secretion. — Nearly all 
diseases are characterized by some excess, defect or perversion 
of secretion and the major portion of therapeutic procedures 
are directly addressed to the alleviation of these conditions. 
Drug therapy is dependent on the action of chemicals to 
right the difficulties. We have only to note the names of 
classes of drugs to realize how extensively they are used to 
control secretion. Astringents, tonics, cathartics, diuretics, 
diaphoretics, expectorants, emmenagogues, sialagogues, er- 
rhines, etc., each drug in every class being a more or less 
intense poison. If it were not poisonous it would not act so 
promptly. It is not a food, hence cannot become incorporated 
in the protoplasm of the body cells. Being a foreign sub- 
stance, our bodies attempt to dissolve and eliminate it. Why 
pilocarpin is eliminated in the saliva and sweat in preference 
to the alimentary tract or kidneys is difficult to explain but 
the fact that it is forced out of the body as quickly as pos- 
sible ought to be sufficient evidence against using it. Drugs 
which promote secretion, do so at the expense of the vitality 
of the body. They call forth an excessive amount of energy 
in order to be ejected from the body. 

It seems to us that a sufficient number of cases have been 



10S PRINCIPLES OF OSTEOPATHY. 

treated successfully by physiological means to warrant the 
cessation of the use of drugs. 

Unimpeded Blood Supply. — The second necessary con- 
dition for normal secretory activity has been stated as an un- 
impeded blood supply. This is a prerequisite for good func- 
tioning which cannot be ignored. This question of circula- 
tion is the basis of osteopathic practice, therefore we examine 
every case with special attention, knowing that if the proper 
amount of blood is not furnished to the secretory tissues,, 
under a proper speed and tension, improper function- 
ing will result. We know that the blood stream is subject to 
many influences of a mechanical character, external pressures 
exerted by subluxated bones, contracted muscles, etc., but far 
in excess of these purely structural difficulties we find that the 
influence of vaso-motor nerves is a condition which requires 
our attention. Secretory cells depend on the blood being 
brought to them under a certain pressure and speed. These 
conditions of the blood stream are governed largely by the 
vaso-motors. Vaso-motors act according to stimuli reaching 
their governing centers over sensory nerves ending in all 
the body tissues, but principally those ending in skin, mucous 
membrane and muscle. These sensory nerves are subject to 
mechanical, thermal and chemical stimuli. Therefore our 
search for causes of abnormal secretion compels us to investi- 
gate not only the prominent symptoms of the case but to note 
the structural conditions along the course of the nerves which 
control the secretory tissue. Palpation will usually discover 
some lesion which is the result of intense mechanical, thermal 
or chemical stimulation. The history of the case will fre- 
quently aid us in learning what the original stimulus was. 

Proper Food. — The third prerequisite for perfect se- 
cretion is the presence of proper elements in the blood to 
supply the needs of the secretory cells. The cases are very 
few in which the blood does not contain sufficient materials out 
of which the secretion may be formed. The secretion of the 
mammary glands requires large amounts of proper food ma- 
terial in their blood supply. The treatment of defective or 
perverted mammary activity is frequently dietetic. After all 



PRINCIPLES OF 0STE0PATPI&1& 109 

obstructions to the blood supply have been removed, the quality 
of the blood must be considered. Quality, elaboration being 
normal, depends on the food eaten. 

Innervation. — The last condition, not in order of im- 
portance, necessary for proper secretion, is proper innervation. 
This fact is the recent addition to our knowledge of the 
mechanism of secretion. Its great importance can be grasped 
in an instant and makes the osteopathic idea of secretion and 
its control appear decidedly rational. 

Many phenomena heretofore unexplainable are now clearly 
understood by physiologists. So long as secretion was be- 
lieved to be controlled by vaso-motor nerves it was difficult 
to account for the lack of perspiration while the blood vessels 
of the skin are full of blood, or why the skin should perspire 
when pallid and bloodless. 

Knowledge of secretory nerves has been in the posses- 
sion of scientists for fifty years. In 1851 Ludwig demon- 
strated that stimulation of the chorda tympani nerve caused 
a rapid secretion from the submaxillary gland. Beginning 
with this important discovery experiments have been made to 
confirm a like control to other glands. Sufficient proof has 
been secured to establish nerve control as one of the important 
factors in the activity of secretory tissue. 

The secretory and vaso-motor nerves are usually in the 
same nerve bundle, hence experimentation with them inde- 
pendently is a difficult matter. The structural lesions found 
in connection with the perverted secretion usually exert an 
equal influence on both sets of nerves. It appears that both 
sets of nerves are not equally responsive to thermal or chemical 
stimuli as may be noted by the clinical picture of fever, hot 
dry skin. The addition of heat for therapeutic purposes suc- 
ceeds in arousing the secretory cells in the skin and perspira- 
tion starts. The use of heat to excite perspiration is an ex- 
cellent therapeutic procedure. It affects secretion reflexly, i. 
e., the sensory nerves of skin convey impressions to the cen- 
tral nervous system and then a change in the tension of the 
blood vessels on the surface takes place, together with an 
increase in the activity of the sweat glands. 



no PRINCIPLES OP OSTEOPATHY. 

Osteopathic Pathology. — Since so much is said about 

the necessity for a perfect circulation our readers may gain 
the impression that osteopathic pathology is entirely "humoral" 
in character. We do not wish this idea to become fixed in 
your minds. It is sufficient to call your attention to the 
stress put upon the facts set forth in this chapter that the in- 
egrity of the individual cell is all important, that the individual 
cells are governed by nerve influence, and if this influence be 
perverted they may refuse that which is brought to them by 
the blood. The fact that all cells can secrete while blood ves- 
sels are tied and some times fail to secrete when blood vessels 
are full, demonstrates a two- fold influence controlling secre- 
tion, one over the cell, the othes over the blood vessel. Thus 
we note that osteopathic pathology is as much "cellular" as 
"humoral." 

Therapeutics. — Having taken this general view of the 
conditions necessary for normal secretory activity we may 
note some of the general principles of therapeutics used to 
correct abnormalities. 

First, the blood must circulate actively in order to main- 
tain its vitality. Sluggishly moving blood, as in conditions 
where venous circulation is interfered with, is not conducive 
to good secretion. 

Second, a moderate increase in the circulation in a gland 
usually increases its activity, i. e., vascularity, within certain 
limits is conducive to perfect physiological action. 

Our therapeutics comprehend the safest and hence the 
best means of regulating the circulation in secretory tissues. 

There is no doubt that the pharmacopeia records many 
drugs whose action is rapid and effective so far as securing 
activity or decrease of secretion is concerned, but the element 
of danger, i. e., their destructive power is great. Often- 
times their action does not stop at the point desired or limit 
its effect to the therapeutic action sought. 

Direct Manipulation. — The simplest way of increasing 
the amount of blood in a secretory tissue is by direct manipu- 
lation. Simple massage of a mammary gland will greatly in- 
crease the amount of blood in it. This direct manipulation is 



PRINCIPLES OF OSTEOPATHY. in 

only transitory in its effect and hence not used by the osteo- 
path. 

Hyperaemia of the Governing Center. — Stimulation of 
the circulation in a gland may be secured by increasing the 
amount of blood in its governing center in the nervous system. 
In order to use this form of stimulation successfully one 
must possess an extensive knowledge of the connections of 
the gland with the nervous system, also a knowledge of the 
blood vessels of the gland. 

Effect on Heart Beat — Any manipulation which does 
not affect the heart beat and hence the initial force of the 
blood current will not have a lasting effect in a local area. 
All manipulations which aim to affect the circulation of a 
gland must be intense and prolonged sufficiently to bring 
about a general readjustment of the circulation. The force 
of the heart beat and the resistance of the arterioles must both 
be affected. Such an effect will tend toward permanency. 

The circulation of definite areas is governed within 
fairly well marked areas of the spinal cord and we can effect 
these areas by indirect manipulations, but it would not be 
conducive to the benefit of the whole body if one portion of 
it could be permanently excited or depressed by any thera- 
peutic means whatsoever ; co-operation of all portions is neces- 
sary to maintain the activity of any one portion. This fact 
proves that our therapeutics must be far-reaching in their 
effects. Therefore to increase the activity of a gland we must 
affect not only the tension of the blood vessels by means of 
vaso-motor nerves but also the force of the blood stream, the 
vis a tergo given it by the heart. True it is that the tension 
quickly reacts on the heart but clinical practice demonstrates 
that a longer effect is secured if both factors in the circulation 
are directly affected by manipulation. 

Classes of Stimuli. — Since secretory tissues are under 
the control of secretory and vaso-motor nerves, and these 
nerves respond to at least five forms of stimuli, our thera- 
peutic procedures may comprehend one or all of these forms 
of stimuli. The five forms are, mechanical, thermal, chemical, 



ii2 PRINCIPLES OF OSTEOPATHY. 

electrical and psychical. The osteopath uses all of these. 
Mechanical and thermal are the principle forms. 

Manipulation being the special therapeutic means used 
by the osteopath, we do not desire to take your^time and at- 
tention in a discussion of the other means of affecting secre- 
tory activity which are discussed at length in many useful 
volumes. 

Perspiration. — The secretion of the skin, perspiration, 
is a profound regulating factor in the health of every indi- 
vidual. Its normal activity must be maintained at all times. 
We are called upon frequently to either increase or check it. 
The treatment of fever is largely comprehended in the in- 
crease of this secretion for purposes of heat elimination. 
When we succeed in affecting the respiratory glands so that 
they will accept the material brought to them by the cutaneous 
blood vessels we have in large measure solved the problem 
of secretion in the kidneys. Any therapeutic procedure which 
favorably affects the blood tension in the skin also affects 
the tension in the kidneys, hence our treatment is not ad- 
dressed primarily to either system of secretory cells but to 
the readjustment of speed and tension of the blood stream 
throughout the body. The cardiac centers and large vaso- 
motor centers are the points which we desire to affect, de- 
pending on the readjustment of tension in the peripheral 
blood vessels to secure the desired results. 

Clinical experience seems to demonstrate that perspira- 
tion can best be established by manipulation in the interscapu- 
lar area, i. e., between the first and seventh dorsal vertebrae. 
A relaxation of the muscles in that area will frequently be 
followed by gentle perspiration over the entire body. This 
result is probably brought about by the inhibitory effect of 
the manipulation around the first dorsal spine, the cardiac 
accelerator center. It is also probably due to the fact that 
the vaso-constrictor fibers to the blood vessels of the head, 
neck, upper portion of the trunk and upper extremities pass 
out of the spinal cord between the second and seventh dorsal 
vertebrae. We have never seen a case of fever in which this 
manipulation was not at least partially beneficial. Its effects 



PRINCIPLES OF OSTEOPATHY. 113 

are far-reaching. The average case of la grippe will yield to 
this treatment almost immediately if the treatment is given 
on the day of the attack. 

It is well known that fear, intense mental or physical 
pain will cause profuse perspiration and pallor of the skin. 
At rare intervals a case is seen where perspiration is intense 
during the sleeping hours and no mental or physical pain is 
experienced, nor is there any tuberculous infection. In all 
these cases the perspiration is a reflex condition and hence 
our manipulation must be addressed to the causative factor. 
Perspiration caused by pain is the most easily relieved by in- 
hibition of the pain. Heat may take the place of inhibition. 

Secretion in the Digestive Tract. — Too much or too 
scanty secretion in the digestive tract is the most common 
condition we have to deal with. Excessive intestinal secre- 
tion, as in diarrhoea, is in all probability more quickly and 
successfully treated by manipulation than by any other means. 
In this condition the secretory cells seem to be directly under 
the control of the spinal centers and respond almost imme- 
diately to inhibitory pressure over these centers. 

In the treatment of lack of intestinal secretion many fac- 
tors must be considered. The average case which comes to 
us with this complaint has been drugged to such a point that 
the integrity of the secretory apparatus is affected. Over 
stimulation by chemical means has resulted in atrophy of se- 
cretory cells. 

We must bear in mind that a large proportion of the so- 
called diseases we are called upon to treat are drug diseases.. 
Structure has many times been ruined by the use of drugs, 
hence we fail because the mechanism is destroyed. 

Pulmonary Respiration. — One more point in regard to 
secretion, i. e., the selective power of cells requires our earnest 
thought and attention. Respiration is a secretory process. 
Therefore our treatment must comprehend the same prin- 
ciples as has been noted in relation to other secretory tissues. 

Importance of the Cell. — The all importance of the 
cell and its harmonious working with its fellows seems to us 
to lend a new dignity and power to the position now being 



ii4 PRINCIPLES OF OSTEOPATHY. 

won by osteopathy. The treatment of disease according to 
the light of physiological knowledge is the system of thera- 
peutics which will win the confidence of the world. Os- 
teopathy is winning that confidence. 



CHAPTER VI. 



THE SYMPATHETIC NERVOUS SYSTEM. 

Unity of the Nervous System. — It gives a wrong im- 
pression to speak of the CEREBRO-SPINAL NERVOUS 
SYSTEM and the SYMPATHETIC NERVOUS SYSTEM, 
as though they are independent of each other. They are parts 
of a single system. They make all parts of the body inter- 
communicative, and make it possible for a slight stimulus to 
cause a widespread response. They convey all impulses of 
a sensory character to the central nerve cells and cause inter- 
nal activity and response to external stimuli. In fact, the 
harmonious action of the tissues in our body depends on every 
cell knowing the condition of every other cell. Each cell is 
capable of perfect life only so long as it is able to communi- 
cate with the central nervous system, ready to give and to 
receive, thus fulfilling the law of reciprocity. 

For convenience of description, the nervous system is 
divided into the cerebro-spinal and the sympathetic. We have 
already said that these are parts of one whole. They are con- 
tinuous anatomically and physiologically. In the attempt to 
write of them separately, we desire you to bear constantly in 
mind their interdependence. 

"The dependence and independence of the cerebro-spinal 
and sympathetic system of nerves may be compared to the 
State and Federal Governments, or the Municipal and State 
Governments. The former run in harmony, when friction 



PRINCIPLES OF OSTEOPATHY. 115 

does not arise, yet the State lives quite a distinct, individual 
life — quite independent of the Federal Government. And the 
life of each is dependent, however, on the other. The inter- 
nal life of each (as of the sympathetic) maintains itself." — 
Byron Robinson in the "Abdominal Brain," page 55. 

Origin. — The sympathetic appears to originate from 
the ganglia on the posterior roots of the spinal nerves. 

(1) Lateral Ganglia. — The substance of the sympa- 
thetic is conveniently divided into four portions : ( 1 ) The 
lateral chains of ganglia, placed one on each side of the ver- 
tebral column. The chains are connected above by the Gang- 
lion of Ribes (French, 1800-1864), situated on the anterior 
communicating artery, and joined below by the Ganglion Im- 
par situated on the anterior surface of the coccyx. These 
chains of ganglia are connected with the cerebro-spinal nerves 
by well marked cords. 

(2) Four Prevertebral Plexuses. — The next prominent 
aggregations of nerve tissue are the great prevertebral plexuses 
situated ventral to the bodies of the vertebrae. The FIRST, 
or Pharyngeal, is situated around the larynx. The SECOND, 
or Cardio-Pulmonary Plexus, lies in the thorax. The THIRD, 
or Solar Plexus, encircles the Coeliac Axis and superior mes- 
enteric artery. The FOURTH is the Pelvic Plexus, which 
governs the generative organs and rectum. 

(3) Visceral Uanglia. — The third part of the sympa- 
thetic tissue is composed of those ganglia placed between the 
coats of viscera, and called the peripheral apparatus or "Au- 
tomatic Visceral Ganglia." (Robinson.) 

(4) Communicating Fibers. — All of these ganglia and 
plexuses are intimately connected with each other by numer- 
ous nerve fibres. These four parts constitute what is com- 
monly known as the SYMPATHETIC NERVOUS SYS- 
TEM. The nerve fibres in the sympathetic system consist of 
both the medullated and non-medullated varieties, i. e., white 
and gray. It is commonly believed that the white are cerebro- 
spinal and the gray are sympathetic fibres, though whether 
they belong to the one or other system cannot be told by ap- 
pearance alone. Function must also be considered. The 



ji6 PRINCIPLES OF OSTEOPATHY. 

fibres in the sympathetic system are principally of the non- 
medullated variety; hence, gray fibres are called sympathetic. 

White Rami-communicantes. — The chains of the lat- 
eral ganglia are connected with the spinal nerves serially by 
two distinct nerve bundles to each ganglion. These bundles 
are called rami-communicantes, and are composed of: (i) 
A bundle of white or cerebro-spinal fibres passing from the 
anterior and posterior roots of the spinal nerves to the 
ganglion, in which a few fibres may end; but the majority 
pass on to be distributed to the prevertebral plexuses, there- 
by giving direct communication between viscera and the spinal 
cord. These white fibres consist of both motor and sensory 
fibres. THE WHITE RAMI-COMMUNICANTES LEAVE 
THE SPINAL CORD BETWEEN THE SECOND DOR- 
SAL AND SECOND LUMBAR VERTEBRAE ONLY. 
Many of the fibres are de-medullated in the lateral ganglia ; 
others retain their sheaths as far as the prevertebral plexuses, 
where they also become de-medullated. The cervical region 
has no white rami-communicantes. 

Distribution. — The nerves in the sacral region which 
correspond to white rami-communicantes, pass to the viscera 
without entering the sympathetic ganglia. We may sum- 
marize what we have written concerning the ending of the 
white rami-communicantes as follows: (i) End in the lat- 
eral ganglia. (2) Pass through lateral ganglia and end in 
prevertebral plexuses. (3) ■ Split up before entering lateral 
ganglia and send some fibres to the ganglia, others to ganglia 
above and below, after passing into its own ganglia. 

Function. — The white rami-communicantes have 
many functions, and these can be determined by a close study 
of distribution and physiological action. The functions may 
be tabulated approximately as follows : First, it has been 
demonstrated that vaso-constrictors pass out of the cord be- 
tween the second dorsal and second lumbar vertebrae ; second, 
cardiac augmentors, ending in the lower cervical ganglia and 
first thoracic ganglion ; third, motor fibres to the plain mus- 
cles of the intestines; fourth, motor fibres to the sphincter 
of the iris leave the cord at the third dorsal and ascend in the 



PRINCIPLES OF OSTEOPATHY. 117 

chain of sympathetic ganglia ; fifth, inhibitory fibres to the 
viscera ; sixth, sensory fibres from viscera. 

In other words, it may be tabulated as follows : The ab- 
dominal splanchnics contain viscero-motor and viscero-in- 
hibitory, vaso-constrictor, vaso-dilator and sensory fibres, 
which are white rami-communicantes. Since no white rami- 
communicantes leave the cord above the second dorsal or be- 
low the second lumbar, the cardiac augmentors and the con- 
strictors to the spincters of the iris probably leave the cord 
as white rami-communicantes in the dorsal region. 

We have thus far considered only those fibres which are 
supposed to originate in the cerebro-spinal system ; at least, 
they are medullated nerves, and hence are considered cerebro- 
spinal in character. 

As we have previously stated, the bond of union be- 
tween the sympathetic and cerebro-spinal systems consists of 
a white and gray bundle. 

Gray Rami-communicantes. — These gray fibres are non- 
medullated and originate in the lateral ganglia, being axis 
cylinder processes of nerve cells in those ganglia, passing 
thence to the spinal nerves and spinal cord. 

Distribution. — They pass first to the anterior, primary 
divisions of the spinal nerves and continue with them to their 
distributive area; or they may pass to the distribution area of 
the posterior division, to the distribution area of the recur- 
rent branch of the spinal nerve, and to the structures (dura) 
surrounding the posterior root of the spinal nerve and to the 
spinal cord. 

Function. — Since the function of the sympathetic sys- 
tem is to control the calibre of blood vessels, the plain muscle 
fibres, and the action of the secretory and excretory glands, 
we may state the function of these gray rami-communicantes 
to be as follows : ( 1 ) Vaso-motor to the blood vessels of the 
skin and skeletal muscles in the area of distribution of spinal 
nerves ; also secretory to the sweat glands, and motor to the 
plain muscle controlling the hairs; (2) vaso-motor to the 
blood vessels in the spinal cord and its membranes. The 
nerves passing from the lateral ganglia to the prevertebral 



n8 PRINCIPLES OF OSTEOPATHY. 

plexuses, therefore, contain white and gray fibres having the 
functions o'f the sympathetic and cerebro-spinal systems, and 
from these prevertebral plexuses, fibres pass to the distal 
ganglia in the walls of the viscera. Thus we see that all the 
ganglia of the sympathetic are closely connected with the 
cerebro-spinal. These ganglia demedullate the spinal nerves 
which enter them, and more fibres leave the ganglia than en- 
ter them. These ganglia have a trophic influence over the 
nerves which pass from them to the periphery. They are 
reflex centers. 

Functions of the Sympathetic System. — "In general it 
may be said that the sympathetic presides over involuntary 
movements, nutrition and secretion, holds an important in- 
fluence over temperature and vaso T motor action, and is en- 
dowed with a dull sensibility." (Robinson's "Abdominal 
Brain.") 

Independent or Dependent. — Whether the action of 
the sympathetic is independent or dependent is no longer 
subject for experiment and discussion. You have seen the 
heart beat after extirpation from the body ; also the ver- 
micular motion of the intestines. These are offered as evi- 
dences of independent action ; but it must be borne in mind 
that under, normal conditions the cerebro-spinal nerves can 
influence these activities, either repressing or augmenting 
them. 

Ganglia. — The ganglia of the sympathetic contain (a) 
nerve cells, (b) afferent fibres, (c) efferent fibres — and are 
therefore governing centers. They are able to receive sensa- 
tion, and transform this into motor impulses, and hence are, 
in a measure, independent. 

Cervical Ganglia of Importance to Osteopaths. — The 
cervical portion of the gangliated cord contains three ganglia 
which are designated as superior, middle and inferior, ac- 
cording to position. These ganglia are important to the os- 
teopath, because they are in a measure affected by direct 
manipulation, i. e., pressure can be transmitted to them through 
the soft tissues over them. 

Superior Cervical Ganglion. — The superior cervical 



PRINCIPLES OF OSTEOPATHY. ng 

ganglion lies on the rectus capitis anticus major muscle and 
sends branches upward which form a plexus around the in- 
ternal carotid artery (carotid plexus). The cavernous plexus 
is a continuation of this. From these plexuses many com- 
municating branches pass to unite with the cranial nerves of 
the cerebro-spinal system. 

Connections. — This ganglion is connected with the 
first four spinal nerves, and the ninth, tenth and twelfth 
cranial. Its branches are distributed on all the blood vessels 
of the head and face. 

Vaso-constriction. — Physiological experiment has de- 
monstrated that this ganglion exercises a vaso-constrictor in- 
fluence over the blood vessels of the head and face. 

Distribution. — "The terminal filaments from the caro- 
tid and cavernous plexuses are prolonged along the internal ca- 
rotid artery, forming plexuses which entwine around the cere- 
bral and ophthalmic arteries ; along the former vessels they may 
be traced into the pia mater ; along the latter, into the orbit,, 
where they accompany each of the subdivisions of the vessel* 
a separate plexus passing with the arteria centralis retinae, 
into the interior of the eye-ball. The filaments prolonged onto 
the anterior communicating artery form a small ganglion, the 
Ganglion of Ribes, which serves, as mentioned above, to con- 
nect the sympathetic nerve of the right and left side." (Gray's 
Anatomy, page 871.) 

Reasoning from the position of the ganglion, in the neck, 
its distribution to blood vessels of the head and face, and its 
vaso-constrictor functions to the vessels, we can readily un- 
derstand why mechanical lesions in the upper cervical region 
can be the cause of grave pathological conditions in the tissues 
of the head and face. Anything which disturbs the normal 
circulation in a definite area will necessarily affect the nu- 
trition of the tissues in that area; therefore, nutritional dis- 
orders of the eye are found to be caused by subluxation of 
vertebrae, or contraction of muscles in relation to the superior 
cervical ganglion. 

Headache. — Since sympathetic branches are distributed 
to the blood vessels of the pia mater, we may reasonably 



i20 PRINCIPLES OF OSTEOPATHY. 

expect to affect the calibre of these vessels in the case of 
congestive headache, by removing all obstructions, — e. g., 
contracted muscles causing dilatation, — to the active func- 
tioning of the superior cervical ganglion. The distribution 
of these sympathetic nerves to the orbit, nose, pharynx, ton- 
sils, palate, and sinuses, explains the possibility — yes, proba- 
bility- — of a mechanical lesion in the upper cervical region in 
these cases. 

Middle Cervical Ganglion. — The middle cervical gan- 
glion is the smallest of the three. "It is placed opposite the 
sixth cervical vertebra, usually upon or close to the superior 
thyroid artery; hence the name of 'Thyroid Ganglion' as- 
signed to it by Haller." It sends branches to the fifth and 
sixth spinal nerves. 

Distribution. — It sends branches to accompany the 
inferior thyroid artery to the thyroid gland, where they com- 
municate with the superior and recurrent laryngeal nerves. 
These branches regulate the calibre of the inferior thyroid 
artery and its branches. The chief nerve trunk passing from 
this ganglion is the middle cardiac nerve. The cardiac aug- 
mentors leave the spinal cord as white rami-communicantes 
to the second, third and fourth dorsal ganglia, then pass up- 
ward to the middle cervical ganglion. This ganglion is con- 
nected with the superior cervical ganglion. 

Function. — The functions of this ganglion are (a) 
vaso-constrictor (through connection with the superior 
cervical ganglion) to the blood vessels of the head and face; 
(b) vaso-constrictor to the vessels of the thyroid gland; (c) 
augmentor influence to the heart. 

Manipulation. — Therefore, inhibition (pressure) will 
lessen those influences, and stimulation (make-and-break 
pressure) will increase them. Since sympathetic centers 
(ganglia) control vaso-motion and secretion, we may consider 
that this ganglion controls vaso-motion and perspiration in 
the area of distribution of the fifth and sixth cervical spinal 
nerves. 

Inferior Cervical Ganglion. — "The inferior cervical 
ganglion is situated between the base of the transverse pro- 



PRINCIPLES OF OSTEOPATHY. 121 

cess of the last cervical vertebra and the neck of the first 
rib, on the inner side of the superior intercostal artery." 

Distribution. — It connects with the ganglion above, 
and the fibres which connect it with the first thoracic ganglion 
pass both in front of and behind the subclavian artery. Its 
chief branch is the inferior cardiac nerve, which communi- 
cates with the middle cardiac nerve and the recurrent laryn- 
geal nerve. It sends gray rami-communicantes to the seventh 
and eighth cervical nerves ; also some branches which pass up- 
ward to the vertebral artery. The fibres which encircle the 
subclavian artery are called the Annulus of Vieussens, and 
some fibres to the cardiac nerve are given off from it. 

Function. — From this distribution we may draw the 
following conclusions as to the function of the inferior cervical 
ganglion; (a) It is vaso-motor to the area of distribution of 
the seventh and eighth cervical nerves; (b) it controls per- 
spiration in this same area; (c) it is vaso-motor to the ver- 
tebral artery and its branches in the posterior fossa of the 
skull; (d) vaso-motor to the internal mammary, inferior thy- 
roid, and nervi comes phrenici arteries; (e) augmentor in- 
fluences to the heart. 

Manipulation. — Treatment on this ganglion would les- 
sen its vasco-constrictor influence over the arteries named, 
and they would then carry more blood at a slower rate. The 
stimulation of this ganglion would raise blood pressure in 
the area it controls, and augment the force of the heart. 

Recapitulation. — It has been mentioned that the cervi- 
cal ganglia receive no white rami-communicantes from the 
cervical nerves, and that vaso-constrictor fibres pass from 
cerebro-spinal to the sympathetic system in the white rami- 
communicantes between second dorsal and second lumbar 
vertebrae; therefore, the constrictor influence manifested by 
the cervical sympathetics is derived from the second, third 
and fourth dorsal. They derive fibres also from the upper 
thoracic region, as follows: (a) augmentor fibres to the 
heart from the second, third and fourth dorsal; (b) secretory 
fibres to the salivary glands, second and third dorsal ; (c) 
pupilo-dilator and motor fibres to the involuntary muscles of 



122 PRINCIPLES OF OSTEOPATHY. 

the eye and orbit from second and third dorsal; ( d) afferent 
fibres whose stimulation causes activity of the vaso-motor 
center in the medulla. 

Thoracic Ganglia. — "The thoracic portion of the gan- 
gliated cord consists of a series of ganglia which usually 
correspond in number to that of the vertebrae, but from the 
occasional coalescence of two, their number is uncertain. 
These ganglia are placed on each side of the spine, resting 
against the head of the rib and covered by the pleura cos- 
talis ; the last two are, however, anterior to the rest, being 
placed on the sides of the bodies of the eleventh and twelfth 
dorsal vertebrae. The ganglia are small in size, and of a 
gray color. The first, larger than the rest, is of an elongated 
form, and frequently blended with the last cervical. They are 
connected together by cord-like prolongations of their sub- 
stance. In the thoracic region the ganglia are connected with 
the spinal nerves by both white and gray rami-communi- 
cantes/' — (Gray's Anatomy, Page 804 in 1901 Edition.) 

Rami-efferentes. — The rami-efferentes or branches of 
distribution, are divided into an internal and external set. 
The external branches are smaller, being distributed to the 
bodies of the vertebrae and their ligaments. The internal 
branches may properly be divided into an upper and lower 
group, which are distributed to the viscera of the thorax and 
abdomen. 

Upper Five Thoracic Ganglia. — The upper five thoracic 
ganglia send branches which are distributed around the upper 
portion of the descending aorta. From the second, third and 
fourth ganglia are given branches to the posterior pulmonary 
plexus, which control the tissues of the lungs. You will re- 
member that the pneumogastric nerves are the motor, sensory 
and trophic nerves to the air passages. The sympathetic, 
second to seventh dorsal, are vaso-motor and trophic to the 
blood vessels of the tissues of the lungs. We have now laid a 
foundation of anatomical and physiological facts upon which 
we may base our principles of treatment. The upper thoracic 
region is an important one, because in it we find not only those 
white rami-communicantes which are distributed to the aorta 



PRINCIPLES OF OSTEOPATHY. 123 

and lungs, joining with the pneumogastric nerve to complete 
the plexuses which control lung action, but also those white 
rami-communicantes which ascend to the cervical ganglia, and 
are distributed as follows : 

Nerve Distribution. — "(1) Pupilo-dilator fibres pass 
by rami-communicantes from the first, second and third tho- 
racic nerves, ascend in the sympathetic cord to the superior 
cervical ganglion to form arborizations around the cells. 
These gray fibres pass to the Gasserian Ganglion and reach 
the eye ball by the ophthalmic division of the fifth and long 
ciliary nerves; (2) motor fibres to the involuntary muscles to 
the orbit and eyelids, from the fourth and fifth thoracic nerves, 
following a similar course; (3) vaso-motor fibres to the head, 
secretory fibres to the submaxillary glands, and pilo-motor 
fibres to the head and neck, are derived from the upper tho- 
racic nerve, and reach their area of distribution, after similar 
interruption, in the superior cervical ganglion; (4) the ac- 
celerator fibres to the heart are derived from the upper tho- 
racic nerves, and end similarly in the middle and lower 
cervical ganglia, gray fibres in the cervical cardiac nerve com- 
pleting the connection." — (Gerrish's Anatomy, Page 18.) 

Interscapular Region. — Therefore, we have an area 
extending from the second to the seventh dorsal, in which 
we must make careful examination for lesions affecting vaso- 
motor, trophic and secretory activity in the thoracic viscera, 
upper extremities, and structures of the head, face and neck. 
This explains to you why a treatment in the interscapular 
region has such far-reaching effects. 

A Case Illustrating the Cilio-spinal Center. — As an il- 
lustration of the nerve connection between the cilio-spinal 
center, first, second and third dorsal and the eye, I wish to 
call your attention to a patient now in the clinic. There 
was extensive inflammation of the conjunctiva of the right 
eye, sight in that eye was almost gone on account of the opacity 
caused by the inflammation of the conjunctiva over the cornea. 
This condition was present for five years. The inflammation 
had traveled to the nasal duct, and as a result it was closed. The 
duct had been opened by the surgeon's knife long before we 



i2 4 PRINCIPLES OF OSTEOPATHY, 

saw the case. A close examination of the center likely to 
be irritated in such a condition disclosed the fact that the area 
between the first and third dorsal vertebrae was exceedingly 
sensitive, and, most interesting of all, pressure on this area 
caused intense pain in the inflamed eye, and caused the pupil 
to dilate. The muscles in the interscapular area were very 
much contracted. Treatment was given, and in proportion 
to the amount of relaxation gained in the interscapular area, 
the inflammation in the conjunctiva subsided. After one 
month's treatment, the patient could see to thread a needle, 
using only the formerly diseased eye. Pressure at the third 
dorsal spine still causes the patient to speak of a sense of 
pressure or swelling in the eye. (Two years have passed 
since this was written. The patient has continued to have 
perfect use of the eye.) 

The following extract from "The Osteopath" in regard 
to this case, is of interest to us while considering the sympa- 
thetic nervous system: "It is not surprising that diseases of 
the eye should affect the sympathetic nerve, and that by that 
path the center known as the 'cilio-spinal.' But by what sen- 
sory path would the influence of pressure be carried to the 
eye? We know of none. From the first two dorsal nerves, 
which are identical with the cilio-spinal center, sympathetic 
fibres are distributed to the dilating muscle fibres of the iris, 
and when stimulated cause dilatation of the pupils. From 
the third dorsal nerve fibres are distributed which regulate the 
calibre of the blood vessels of the eye. Under the pressure, 
either set of these fibres may be affected. The first may be 
stimulated, dilating the muscles of the iris so as to press upon 
filaments of sensitive nerves ; or, the pressure may inhibit the 
vaso-constrictor function of the other nerve, and by dilating 
the arterioles cause pressure upon the sensitive nerve ; or, both 
causes may operate and thus induce the pain. The abundant 
supply of sensory nerves to the ciliary muscle, iris and cornea, 
from the nasal branch of the ophthalmic division of the fifth 
nerve and the short ciliary branches from the ciliary (lenticu- 
lar or ophthalmic) ganglion makes it conceivable that any 
change of arterial pressure might affect these nerves to the 



PRINCIPLES OF OSTEOPATHY. 125 

extent of causing pain. It seems reasonable to conclude that 
there was no inflammation, but congestion, and partial paraly- 
sis of the vaso-constrictor nerve." — (A. E. Brotherhood, D. 
O., D. Sc. O., in "The Osteopath," Vol. V., No. III.) 

Effects of Treatment, First to Seventh Dorsal. — Treat- 
ment in the interscapular region, first to seventh vertebrae, 
may reasonably be expected to affect the heart beat, the nu- 
tritional circulation in the lungs, and the circulation in the up- 
per extremities, head, neck and face. 

The remainder of the dorsal area constitutes what is 
called the splanchnic region. Three splanchnic nerves are 
given off from this region to be distributed to the prevertebral 
plexuses in the abdominal cavity. 

The Great Splanchnics. — The first is called the Great 
Splanchnic and takes origin from the sixth to the tenth dorsal 
nerves, and probably receives many filaments from the upper 
dorsal nerves. It is a large nerve trunk and contains many 
medullated nerves from the cerebro-spinal system. Its course 
is downward and inward, perforates the crus of the dia- 
phragm and ends in the semilunar ganglion. Some fibres 
end in the renal and suprarenal plexuses. 

Lesser Splanchnic. — The Lesser Splanchnic arises from 
the tenth and eleventh ganglia and their connecting cord. 
It also takes a downward and inward course, piercing the 
crus of the diaphragm, and ends in the Coeliac Plexus. It 
communicates with the Great Splanchnic, and sometimes sends 
fibres to the renal plexus. 

Least Splanchnic. — The Least, or Renal Splanchnic, 
arises from the last thoracic ganglion and ends in the renal 
plexus. It sometimes communicates with the lesser splanch- 
nic. 

Functions. — First, vaso-constriction ; second, viscero- 
inhibition. I mention merely those functions which have been 
well demonstrated by physiological experiments and osteo- 
pathic practice. 

Theory. — The osteopath reasons as follows concerning 
this Splanchnic area: Since the Great Splanchnic ends in 
the semilunar ganglion, from this ganglion and plexuses 



126 PRINCIPLES OF OSTEOPATHY. 

around it fibres are distributed to the blood vessels of the 
stomach, liver, spleen and intestines; therefore, we operate in 
the area between the fifth and tenth dorsal spines for vaso- 
motor effects on the above-mentioned viscera. Again, the 
great splanchnic sends viscero-inhibitory fibres to the mus- 
cular layers of the stomach and intestines; hence, we con- 
trol excessive muscular activity in these viscera by removing 
obstructions to the normal inhibitory influence of these nerves. 
The Lesser Splanchnic has the same functions, but exer- 
cises its functions chiefly on that portion of the intestinal 
muscular layer comprised in the area supplied by the su- 
perior mesenteric artery; therefore, the tenth and eleventh 
dorsal area is a vaso-motor and motor-inhibitory center for a 
segment of the intestines. The renal splanchnics exert a vaso- 
constrictor influence on the blood vessels of the kidneys, and 
the osteopath secures vaso-motor effects on the blood vessels 
of the kidneys, and hence effects secretion by removing ob- 
structions to the normal influence of this nerve. 

The twelfth dorsal spine marks a renal center. These 
nerves contain sensory fibers which carry sensation from the 
prevertebral plexus in the abdomen to the spinal cord. There- 
fore, a disturbance in the viscera can reflex its painful sen- 
sations to the area of greater sensibility which is in close 
central connection with the seat of disturbance. 

It should be borne in mind that the power of movement 
resides in the muscular wall of the intestine and is initiated by 
the Automatic Ganglia in its walls, which are excited by the 
pressure of food. We may state that the intestines possess 
an intrinsic nerve apparatus which initiates peristalsis, but 
the control of the movement after it is initiated is exercised 
by cerebro-spinal nerves. The pneumogastric nerve exercises 
a decided motor influence over the intestines. And, as pre- 
viously stated, the great and lesser splanchnics are inhibitory 
nerves to the musculature of the intestines. 

Lumbar Ganglia. — Four small ganglia, connected 
above and below by intercommunicating fibres, constitute the 
lumbar portion of the sympathetic ganglia. These ganglia 
are connected with the cerebro-spinal lumbar nerves by rami- 



PRINCIPLES OF OSTEOPATHY. 127 

communicantes. The first and second ganglia are the only 
ones in this region receiving white rami-communicantes. The 
functions which we found were exercised in the lower dorsal 
area are continued into the lumbar ganglia as far as the sec- 
ond. These ganglia send fibres to the aortic plexus, the hypo- 
gastric plexus, and thence to the pelvic plexus. They also 
send branches, as in other regions, to the blood vessels sup- 
plying the bones and ligaments of the spinal column. 

Since vaso-constrictor fibres do not enter the sympathetic 
ganglia below the second lumbar, we may reasonably expect 
to influence the circulation of the lower extremities by manipu- 
lations in this area. 

The descending colon and rectum are supplied with 
viscero-inhibitory fibres from this area. Vaso-constrictor 
fibres are supplied to the blood vessels in the lower portion 
of the abdomen. The influence exerted by the lumbar sym- 
pathefics may be tabulated as follows : 

1st: Viscero-inhibitory to descending colon and rectum. 

2nd : Vaso-constrictor to lower abdominal blood vessels. 

3rd: Vaso-constrictor to the blood vessels of the penis. 

4th : Vaso-motor fibres to the blood vessels of the blad- 
der. 

5th : Vaso-motor fibres to the blood vessels of the 
uterus. 

6th : Vaso-constrictor to the blood vessels of the pelvic 
viscera. 

7th: Motor to vas deferens (male), round ligament 
(female). 

8th : Vaso-constrictor to the blood vessels of the lower 
extremities. 

Sacral Ganglia. — The pelvic portion of the sympathetic 
chain usually consists of four ganglia situated along the inner 
side of the sacral foramina, and communicates with the four 
upper sacral nerves. These ganglia are connected with each 
other, as in other regions. The two chains connect by the 
Ganglion Impar on the anterior surface of the coccyx. 

Distribution. — The rami-efferentes are distributed to 



128 PRINCIPLES OF OSTEOPATHY. 

the pelvic plexus ; or a plexus on the middle sacral artery, 
and to vertebrae and ligaments in the sacral region. 

"Through the pelvic plexus, the pelvic viscera are sup- 
plied with motor, vaso-motor and secretory fibres." (Ger- 
rish's Anatomy, Page 648.) 

The rami-communicantes in the sacral region are gray, 
hence, the influence of the cerebro-spinal system is carried 
down from the upper lumbar ganglia. 

"Below the second lumbar vertebra they are also of the 
gray peripheral variety." ('VYbdominal Brain/' Page 31.) 

In the sacral region the spinal nerves are distributed 
directly to the pelvic viscera ; some fibres pass into the pelvic 
plexus, thence to the viscera. 

The sacral region offers an area in which the osteopath 
can secure an influence on pelvic viscera without the exten- 
sive sympathetic connections encountered in other regions of 
the spine. 

Function. — These sacral nerves are : 

1st: Vaso-dilator to the vessels of the penis and vulva. 

2nd : Motor fibres to the rectum. 

3rd : Motor fibres to the bladder. 

4th : Motor fibres to the uterus. 

Cardiac Plexus. — The three great prevertebral plex- 
uses must now engage our attention. The first one, the car- 
diac plexus, is situated at the base of the heart, and in the con- 
cavity of the arch of the aorta; this portion is called super- 
ficial, while the deep portion lies between the trachea and the 
aorta. 

Position and Formation. — The cardiac plexus is formed 
by fibres from the pnuemogastric and cervical cardiac sym- 
pathetics. "It is very common to find upper cervical cardiac 
branches of the vagus and sympathetic united to form a com- 
mon trunk. In other cases, the nerves branch and communi- 
cate with each other in a plexiform manner." (Morris's 
Anatomy. ) 

The cardiac nerves form the cervical sympathetic chain; 
all enter the cardiac plexus, but their distribution is variable. 
The superficial plexus receives the "left superior cardiac nerve 



PRINCIPLES OF OSTEOPATHY. 129 

of the sympathetic and the left inferior cervical cardiac branch 
of the pneumogastric.'' — (Morris's Anatomy.) 

The deep cardiac plexus "receives all the other cardiac 
nerves." From the superficial cardiac plexus branches pass 
to the plexus around the right coronary artery and pass to the 
left lung to join the anterior pulmonary plexus. 

From the deep cardiac plexus branches are distributed 
to the anterior pulmonary plexus of both sides, the left coro- 
nary plexus, right auricle, superficial cardiac plexus, and 
right coronary plexus. 

Pulmonary Plexus. — Thei anterior pulmonary plexus 
is formed by a branch of the pneumogastric and the sympa- 
thetic. It is situated on the anterior surface of the bronchi 
and the branches enter the lung on the bronchus. 

The posterior pulmonary plexus is formed by the pneu- 
mogastric and fibres from the second, third and fourth tho- 
racic ganglia of the sympathetic. Its branches enter the lung 
on the posterior aspect of the bronchus. 

Physiology. — Physiological experiments have demon- 
strated that the pneumogastric is motor to the muscles of the 
bronchioles, sensory and trophic, while the sympathetics are 
vaso-motor and trophic. Therefore, the function of the lungs 
and heart can be affected by operating on the inter-scapular 
region. 

Functions. — The functions of the thoracic plexus are : 

1st: Cardiac augmentors, per sympathetics. 

2nd : Cardiac inhibitor, per pneumogastric. 

3rd : Vaso-constrictor to coronary arteries, per pneumo- 
gastric. 

4th : Vaso-constrictor to bronchial arteries, per sympa- 
thetics, first to fifth dorsal. 

5th : Sensory fibres to the pleura and lungs, per sym- 
pathetic, first to fifth dorsal. 

6th : Sensory fibres to heart and pericardium, per sym- 
pathetic, second to fifth dorsal. 

7th : Broncho-constrictor, per pneumogastric. 

8th : Broncho-dilator, per pneumogastric. 



13© PRINCIPLES OF OSTEOPATHY. 

9th : Sensory fibres to mucous lining of air passages, per 
pneumogastric. 

Treatment. — A true inhibitory treatment would pro- 
duce greatest effect on the heart, if administered over the 
middle and inferior cervical ganglia. The heart would be 
slowed. Such a treatment is rarely given, because nearly 
every case presents some physical lesion, which if removed, 
allows normal impulses to meet in the cardiac plexus and be 
re-organized for proper distribution. 

Always bear in mind that a plexus is a re-organizing 
center for nervous impulses, and we can hope only to regu- 
late the function of an organ by attempting to equalize the 
impulses reaching its controlling plexus. This equalizing 
process is not ordinarily secured by the administration of 
inhibition to a definite nerve trunk which ends in the plexus, 
but by removing a lesion, — usually bony or muscular — which 
is affecting the ' nerve fibre in the direction of increase or 
decrease of function. 

The region between the scapulae is in close central con- 
nection with the lungs, pleura, heart and pericardium; hence, 
painful sensations originating in these organs may be re- 
ferred to this area. The muscles in this area will contract 
reflexly from irritation of these organs, or from exposure of 
the skin over them to a change of temperature. Hence, in 
the first instance the contraction is a secondary lesion; in the 
latter, a primary one. 

Pressure in this area practically causes relaxation of 
muscles, removes a lesion ; but the patient experiences a cessa- 
tion of pain, freer respiration, and less rapid action of the 
heart. 

Results. — After administering inhibitory pressure, the 
osteopath realizes that the muscles under his fingers are softer 
than formerly; then he knows that he has actually changed 
the physiological condition of an important tissue. 

Argument. — Coincident with the softening of the mus- 
cles, the heart beats slower; therefore, he has removed an 
irritant to the augmentor fibres of the heart ; the respiration 
is deeper, therefore, a change has been secured in the activity 



PRINCIPLES OF OSTEOPATHY. 131 

of the walls of the thorax, and in the circulation of blood in 
the bronchial and pulmonary blood vessels ; the pain has de- 
creased, therefore, the sensory nerves in the lung tissue are 
no longer irritated by hyperaemic pressure or toxic substances 
in the blood. This illustrates to you why the osteopath studies 
and treats the interscapular region so carefully. 

Solar Plexus. — In the abdominal cavity we find the 
solar plexus, which on account of its great size and wonder- 
ful distribution, Byron Robinson calls the "Abdominal 
Brain.'' 

Location and Formation. — It is placed in front of the 
aorta at its entrance into the abdomen, and surrounds the Coe- 
liac Axis. It consists of two semilunar ganglia, which are placed 
on each side of the coeliac axis, and are connected by a large 
number of fibres which pass above and below the coeliac 
axis. From this circle of ganglia and nerves, fibres are given 
off which are joined by branches of the right pneumogastric, 
and by both small splanchnics. The great splanchnic ends 
in the semilunar ganglion. 

Distribution. — The branches of distribution from the 
solar plexus are prolonged on the branches of the abdominal 
aorta as subsidiary plexuses, taking their names from the 
arteries they accompany, as splenic, gastric, hepatic, dia- 
phragmatic, suprarenal and renal, superior mesenteric, inferior 
mesenteric, aortic and spermatic. The ultimate distribution of 
the branches of the solar plexus is to the muscular and secre- 
tory tissues of all the abdominal viscera, and to the muscular 
coat of the arteries supplying these viscera. This great plexus is 
the vaso-motor center for the abdominal viscera. "It is con- 
nected with almost every organ in the body, with a supremacy 
over visceral circulation, with a control over visceral secre- 
tion and nutrition, with a reflex influence over the heart that 
often leads to fainting, and may even lead to fatality." — "Ab- 
dominal Brain," Page 76. 

Function. — We find that the great and the small 
splanchnics and right pneumogastric are the chief contributors 
to the solar plexus, and in order to get a clear idea of the func- 
tions of this plexus, we may tabulate them as follows : 



132 PRINCIPLES OF OSTEOPATHY. 

ist: Viscero-motor to stomach, small intestines, as far 
as sigmoid flexure, per pneumogastric. 

2nd : Sensory to stomach and small intestines, per pneu- 
mogastric. 

"If the pneumogastric nerve be divided during full di- 
gestion in a living animal, in which a gastric fistula has been 
established, so that the interior of the stomach can be ex- 
amined, the muscular contractions will be observed to cease 
instantly; the mucous membrane to become pale and flaccid; 
the secretion of the gastric juice to be arrested, and the organ 
to have become insensible. There can be no doubt, also, that 
stimulation of the pneumogastric nerves causes the stomach 
to contract, and that digestion may, to a certain extent, at 
least, be re-established by stimulation of the peripheral ex- 
tremities of the divided nerves. " — (Chapman' Phys., Page 
680.) 

3rd : Viscero-inhibitory, per splanchnics. 

4th : Vaso-motor, per splanchnics. 

5th : Sensory, per splanchnics. 

6th : Sensory, per pneumogastric and splanchnics. 

The fibres of the great and small splanchnics come from 
the sympathetic ganglia in the dorsal region, sixth to eleventh. 

These ganglia may receive fibres from some of the upper 
dorsal. 

Centers. — The facts just stated give us a foundation 
for osteopathic treatment to influence motion, sensation, se- 
cretion, and vaso-motion in the abdominal viscera. The area 
in the vertebral column which we may consider as containing 
centers for these various functions lies between the sixth and 
eleventh dorsal spines. The fibres from this region have a 
segmental distribution to the abdominal viscera ; therefore, the 
stomach, liver, gall bladder, spleen and intestines, each have 
a limited portion of this area which is their special center ; at 
least, painful sensations are reflexed from them to a definite 
point in the vertebral column between the sixth and eleventh 
dorsal spines. The enormous regulative influence which can 
be excited by an osteopathic treatment in this area is being 
demonstrated daily. 



PRINCIPLES OF OSTEOPATHY. 133 

We have already mentioned the fact that the intestines 
will contract after being separated from the body, thereby, 
proving that the intrinsic power to cause movement lies in the 
nervous mechanism in the gut walls. Keep constantly in 
mind the regulative character of the impulses which enter the 
''abdominal brain" over the pneumogastric and splanchnic 
nerves. 

The vaso-motor phenomena in this area have been dis- 
cussed in another chapter. 

Hypogastric Plexus — Location and Formation. — The 
great re-organizing center for the pelvic viscera is called the 
hypogastric plexus, which lies anterior to the fifth lumbar 
vertebra. It is formed by a continuation of fibres from the 
aortic plexus which are joined by fibres from the lumbar 
sympathetic ganglia. In front of the sacrum the plexus divides 
into two portions, which join the pelvic plexuses lying on each 
side of the rectum and bladder, in the male, and of the rectum, 
vagina and bladder in the female. 

Pelvic Plexus. — These pelvic plexuses contain many 
small ganglia, and are joined by fibres from the upper sacral 
sympathetic ganglia, and by direct branches of the second, 
third and fourth sacral cerebro-spinal nerves. 

Distribution. — The branches of these plexuses are dis- 
tributed on the coats of the arteries to the pelvic viscera, and 
frequently enter the substance of the organ. 

Subsidiary Plexuses. — According to the artery fol- 
lowed, we have subsidiary plexuses, called hemorrhoidal, vis- 
ceral, prostatic, vaginal, and uterine. 

Functions. — The functions of the pelvic plexus are as 
follows : 

(1) Vaso-constrictor, (2) vaso-motor, (3) sensory, (4) 
viscero-inhibitor, per hypogastric plexus. 

(5) Motor to rectum, vagina and bladder, (6) sensory 
to rectum, vagina and bladder, (7) vaso-dilator to sexual or- 
gans, erectile tissue, (8) viscero-constrictor to neck of uterus, 
per second, third and fourth sacral. 

Summary. — With the arrangement and functions of 



134 PRINCIPLES OF OSTEOPATHY. 

these nerves well in mind, we recognize two paths over which 
we can influence the pelvic viscera : 

( i ) Sensor}- influences may be reflexed through the hypo- 
gastric plexus, and thence to the second lumbar ; or, they may 
pass over sacral nerves to the same point, second lumbar. In 
connection with disturbance of the pelvic viscera, pain may 
be reflexed on to the back of the sacrum, or to an area around 
the second lumbar. Disturbance of function in the uterus 
Causes reflex sensitiveness at fourth and fifth lumbar. 

(2) Vaso-constrictor influences come through hypogastric 
plexus from spinal nerves about second lumbar. 

(3) Vaso-dilator influences come directly to the pelvic 
plexus from second and third sacral nerves ; nervi erigentes. 

(4) Viscero-motor influences chiefly from second, third 
and fourth sacral. 

(5) Viscero-inhibitory influences, chiefly through hypo- 
gastric plexus, probably from upper lumbar spinal nerves. 

We have therefore a vaso-constrictor center for pelvic 
viscera at second lumbar ; a vaso-dilator and motor center 
at second and third sacral. 

Automatic Visceral Ganglia. — The last portion of the 
sympathetic is but little known, and physiologists have re- 
frained from speculating on it until more definite knowledge 
is obtained. 

Byron Robinson mentions a number of "automatic vis- 
ceral ganglia" situated in the walls of the hollow viscera. The 
fact that the heart, intestines, uterus, bladder and fallopian 
tubes will contract rhythmically in response to mechanical 
stimulation after all nerve connections are severed, seems to 
prove the existence of ganglia in the walls of these viscera 
which are capable of receiving sensation and sending out 
motor impulses. 

Conclusions. — We will therefore conclude that the 
sympathetic system can act independently of the cerebro- 
spinal ; that it receives sensation, and initiates motion ; gives 
tone to the arteries, and controls secretion. We influence the 
functions of the sympathetic through its connection with the 
cerebro-spinal system. 



PRINCIPLES OF OSTEOPATHY. 135 



CHAPTER VII. 



HILTON'S LAW. 

In the years 1860-61-62 a series of lectures was delivered 
by John Hilton, F. R. S., F. R. "C. S., "On the Influence of 
Mechanical and Physiological Rest in the Treatment of Ac- 
cidents and Surgical Diseases, and the Diagnostic Value of 
Pain.'' These lectures were afterward published in book 
form under the title of "Rest and Pain." This book is a 
medical classic and worthy of careful perusal by all students 
of medicine. 

The careful observations and reasonings therefrom which 
are reported in "Rest and Pain" explain many of the phe- 
nomena noted in osteopathic practice. We desire to give all 
due honor to this man who was so far in advance of his 
time. 

We shall quote a few paragraphs from "Rest and Pain" 
which have a direct bearing on osteopathic methods of diag- 
nosis and therapeutics. 

The Law Stated. — After careful study of the distribu- 
tion of nerves throughout the body, Hilton sums up his ob- 
servations in a terse sentence which we choose to call a law. 
"The same trunks of nerves zvhose branches supply the groups 
of muscles moving a joint, furnish also a distribution of 
nerves to the skin over the insertion of the same muscles, and 
the interior of the joint receives its nerves from the same 
source." 

Hilton further states that "Every fascia of the body has a 
muscle attached to it, and that every fascia throughout the 
body must be considered as a muscle." 

Methods of Studying Anatomy. — These statements 



136 PRINCIPLES OF OSTEOPATHY. 

lead us to a closer study of each joint and its controlling 
muscles and governing nerve or nerves. We may study 
anatomy under artificial divisions such as Osteology, Syndes- 
mology, Myology, etc., and still, after securing an accurate 
technical knowledge of details, we have nothing of practical 
value. It is in the correlation of these tissues with their in- 
terdependence quite fully understood that we have a working 
knowledge. With this thought of the influence of one tissue 
on another and the harmonious action secured by the com- 
paratively varied distribution of the nerve trunks, we find a 
new and vital interest in anatomy. 

This law is based upon the facts of anatomy and physi- 
ology, and makes our concrete knowledge of these subjects 
of constant practical value in both diagnosis and therapeutics. 
This law shows us the "why" of certain vital and mechanical 
manifestations, and teaches us practical methods of treat- 
ment. 

Example of Hilton's Law. — An example of Hilton's 
law is the distribution of the sciatic nerve to the ankle. The 
muscle moving the joint, the synovial membrane and most of 
the skin over the joint are all innervated by it. 

The Knee. — The knee has three nerves. Each one has 
a motor and sensory control. The extensor muscles and the 
skin over them is innervated by the anterior crural. The flexor 
muscles and the skin over them is innervated by the sciatic. 
The obturator, in addition to these nerves, furnishes sensory 
filaments to the synovial membrane. All the joints of the 
body may be examined in the light of this law. The same 
segment of the central nervous system which gives off a 
purely motor nerve trunk, gives off also a sensory nerve whose 
filaments are distributed over the same area. Thus it is some- 
times necessary to go to the central nervous system to dis- 
cover this association of motor and sensory distribution. In 
practice we always do this, because it is easier to work from 
the center of the areas of distribution. 

The Object of Such a Distribution. — Hilton says : "The 
object of such a distribution of nerves to the muscular and ar- 
ticular structures of the joints, in accurate association, is to 



PRINCIPLES OF OSTEOPATHY. 137 

insure mechanical and physiological consent between the ex- 
ternal muscular, or moving force, and the vital endurance of 
the parts moved, namely, of the joints, thus securing in health 
a true balance of force and friction until deterioration occurs." 

"Without this nervous association in the muscular and 
articular structures, there could be no intimation by the internal 
parts of their exhausted condition." "Again, through the 
medium of the muscular and cutaneous nervous association 
great security is given to the joint itself by those muscles being 
made aware of the point of contact of any extraneous force or 
violence. Their involuntary contraction instinctively makes 
the surrounding structures tense and rigid, and thus brings 
about an improved defence for the subjacent structures." 

The Uniformity of the Law. — "This articular, muscu- 
lar and cutaneous distribution of the nerves is, in my opinion, 
a uniform arrangement in every joint in the body. We may 
find numerous illustrations of the same method of distribution 
in other parts of the body, which have the same definite re- 
lations to each other, and in this respect present the same 
physiological and mechanical arrangement observable in joints. 
This same principle of arrangement, anatomic- 
ally, physiologically, and pathologically considered, is to be 
observed with an equal degree of accuracy in the serous and in 
the mucous membrane. Thus considered, it presents a prin- 
ciple, which, if it has any application in practice, must be one 
certainly of large extent." 

Precision of Nervous Distribution to Muscles. — "The 
great precision with which muscles are supplied by their nerves 
is worthy of remark; and is such that if we have before us a 
contracted muscle, we may be sure of the nerve which must 
be the medium, or the direct cause of it." 

"In studying the supply of nerves to muscles over every 
part of the body, we find a great degree of precision, which 
marks one difference between their distribution and that 
of the arteries." 

Indications for Use of Therapeutics. — "I should say in 
aid of other means, employ this cutaneous distribution of 
nerves as a road or means toward relieving pain and irritation 



138 



PRINCIPLES OF OSTEOPATHY. 



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PRINCIPLES OF OSTEOPATHY. 139 

in the joint. You thus quiet the muscles, prevent extreme 
friction, and reduce muscular pressure and spasm. Thera- 
peutics may certainly reach the interior of this joint and its 
muscles through the medium of the nerves upon the surface 
of the skin, and so induce physiological rest to all the parts 

concerned in moving the joint The advantage 

to be derived arises in this way : Sensibility of the filaments 
supplying the skin being reduced, that influence is propagated 
through the sensitive nerves, to the interior of the joint, and to 
the muscles moving a joint. This diminution of sensibility 
tends to give quietude or perfect rest to the interior of the joint, 
which is one of the most important elements towards the suc- 
cessful issue of the treatment of cases of this kind." 

The Use of Hilton's Law in Physical Diagnosis. — Hil- 
ton's law is applicable in physical diagnosis. The osteopath 
makes constant use of the superficial expressions of nerve 
activity. After having learned the whole course, distribu- 
tion and central connections of the nerve, we can judge 
rightly as to the structures involved, by noting the physiologi- 
cal conditions of all the structures innervated by a definite 
nerve trunk. Hilton applied his law entirely from the physio- 
logical side, i. e., he observed changes in the relations of joint 
structures, but considered the deformity as due to excessive 
physiological action of the muscles in their effort to secure rest 
for the joint surfaces. This is largely true, but he did not 
question how the process was initiated. The osteopath seeks a 
point of stimulus to the nerves controlling a joint or other 
structure, believing that it is of little value to anaesthetize 
nerve endings and give rest so long as this stimulus is allowed 
to arouse impulses in the nerve fibres. 

Comparison of Methods. — To compare methods of us- 
ing Hilton's Taw, we will note one of his cases, and a similar 
one treated osteopathically. In Chapter VIII of "Rest and 
Pain" he describes a case of inflammation of the shoulder 
joint, and mentions that the joint is fixed in a position of rest 
as a result of the association of nerves to the synovial mem- 
brane, the muscles of the joint and the skin over the joint. 
Anaesthesia releases the fixedness of the joint, because the 



Ho PRINCIPLES OF OSTEOPATHY. 

muscles do not contract after the sensory impulses are dead- 
ened by the anaesthetic. He says "Therapeutics may certainly 
reach the interior of this joint and its muscles through the 
medium of the nerves upon the surface of the skin, and so 
induce physiological rest to all the parts concerned in moving 
the joint. I mean to say that these nerves upon the surface 
of the skin being in direct association with the interior of the 
joint itself, we may reduce the muscular spasm as well as the 
sensibility of the interior portion of the joint, by applying our 
anaesthetics with accuracy and with sufficient intensity upon 
the exterior of the deltoid muscle, over the distribution of 
these sensitive filaments. The thought will occur to you at 
once that there is nothing very remarkable in this opinion, 
and that is quite true. The embrocations, however, which 
would ordinarily be suggested for this purpose, are not of a 
character sufficiently potent to alleviate the pain of the patient, 
and are, I believe, seldom employed with a definite idea in the 
mind of the prescriber. I would suggest that we should em- 
ploy our fomentations strongly medicated with bella-donna, 
with opium or with hemlock, instead of using mere fomentation 
of hot water. Some will say, 'Oh, hot water is quite as good ;' 
but I can assure you practically that it is not so." 

You will note that he makes use of the cutaneous reflexes 
to affect the interior of the joint. 

A recent case, corresponding we believe, was treated 
osteopathically with marked success. The inflammation in the 
shoulder joint was not traumatic in origin nor did it appear 
to be rheumatic in character. Hot fomentations would give 
great relief, but did not give sufficient rest to the joint to permit 
of a cure. The fear was entertained that longer rest of the 
articulation would result in adhesion and loss of function in 
the joint. Since the circumflex nerve appeared to be the one 
involved, a careful examination was made of the articulations 
between the sixth and seventh cervical vertebrae. The cir- 
cumflex nerve is made up largely of fibres from the sixth cer- 
vical nerve trunk. Tension and tenderness, together with slight 
rotation of the sixth cervical were noted at this point. The 
osteopath, instead of working over the area of distribution of 



PRINCIPLES OF OSTEOPATHY. 141 

the circumflex, centered his work upon this articulation to 
bring about right relations between the sixth and seventh cervi- 
cal vertebrae. Tension and irritation were removed. The 
circumflex nerve ceased to manifest any undue irritation. The 
osteopath almost invariably works from the center to periphery 
instead of the reverse. 

Herpes Zoster. — An example of the osteopath's use, or 
rather recognition of Hilton's law : A case of Herpes Zoster 
located along the course of the left fifth intercostal nerve was 
given a grave prognosis by a homeopathic physician. The 
patient visited an osteopath immediately, hoping that some re- 
lief might be found for the intolerable pain. The eruption 
extended from the spine to the median line in front, forming a 
band about one inch wide. The fifth rib was found rotated 
downward, thus lessening the fifth intercostal space and press- 
ing on the nerve at some point in its course. This rib was 
raised, even though the osteopath's fingers rested directly upon 
the eruption, in order to force the rib upward. The result 
was most) gratifying. Pain decreased almost immediately, 
and there was a rapid change in the appearance of the erup- 
tion, the firey red giving place to a paler color. Those papules 
which were just forming subsided, and those which had formed 
vesicles began immediately to scab. 

The Distribution of an Intercostal Nerve. — The distri- 
bution of an intercostal nerve is to the pleura, intercostal mus- 
cles and skin over these muscles thus corresponding to the dis- 
tribution of nerve trunks to the synovial membrane of a joint, 
the muscles moving the joint and the skin covering the joint. 

The patient could not stand erect, lifting the arm caused 
increase of pain, likewise inspiration was lessened because it 
caused pain. Hilton would say that these movements were 
curtailed to give physiological rest. From the osteopathic stand- 
point, they are reflexes which are not reparative in character, 
hence must be eliminated. Every movement which tended to 
separate the fifth and sixth ribs caused pain, hence the patient 
refrained from making them. The osteopath separated these 
ribs, even though the process of doing so caused pain. The 
structural defect causing the irritation was removed. 



142 PRINCIPLES OF OSTEOPATHY. 

Some of the Evil Results of Rest. — If we are to give 
rest to structures in which pain is located, we will help to fill 
the world wiith stiff joints and serous adhesions, to say nothing 
of the far reaching after effects of these structural defects 
upon the functional activity of the nervous system. 

Hilton's law may be called an anatomical law ; there do 
not appear to be any exceptions to it, especially when supple- 
mented by his statement that "every fascia of the body has a 
muscle attached to it, and every fascia throughout the body 
must be considered as the insertion of a muscle." This carries 
the influence of motor nerves to points covered by their sensory 
companions. 

Head's Law. — Another law, or in this case a compre- 
hensive statement, has been made by Head in his work on the 
"Brain." This is a statement of physiological transference of 
pain from its point of origin to a point of conscious sensation. 
This physiological law is stated as follows : "When a painful 
stimulus is applied to a part of low sensibility in close central 
connection with a part of much higher sensibility, the pain pro- 
duced is felt in the part of higher sensibility rather than in the 
part of lower sensibility to which the stimulus was applied." 

Application of the Law. — This physiological law can 
he applied in two ways. First, we may consider the relative 
sensibility of different portions of a nerve trunk. If a stimulus 
is applied to a nerve trunk at some point in its course between 
its origin and distribution, the pain caused by the stimulus will 
he felt in the area of distribution of the fibres of this nerve 
trunk rather than at the point where the stimulus is applied. 
The skin, mucous or serous membrane and muscle in which 
sensory nerves end are areas of high sensibility compared with 
the trunk of the nerve. The brain is conscious of only the 
areas of distribution of the sensory nerves, hence stimuli ap- 
plied at the points of low sensibility are referred to the areas 
of high sensibility. Thus all lesions causing pressure upon 
nerve trunks cause pain, contraction, or perversion of secretion 
in the areas of distribution. The patient is not thoroughly 
conscious of any location but the area of distribution which is 
an area of high sensibility. 



PRINCIPLES OF OSTEOPATHY. 143 

The cases described under Hilton's law are applicable here. 
In the case of inflamed shoulder joint the patient was not 
conscious of the irritation at the spinal column, — the rotated 
vertebra, — this was an area of low sensibility in the course of 
the nerve trunk. The brain attributed all the trouble to the 
terminations of the nerves in the tissues of the joint. All of the 
reflexes acted accordingly. 

The second application of this law is to the relative inten- 
sity of areas of high sensibility. The areas in which sensory 
nerves end are all areas of high sensibility, but some are 
higher than others. We note in practice that sometimes a 
nerve trunk which supplies several structures will manifest 
pain in a portion of its area of distribution which is not the 
part in which the irritation is located. For example, the 
sensory portion of the obturator nerve is disturbed to the hip 
joint and skin on the inner side of the knee. The skin seems 
to be an area of higher sensibility than the interior of the hip 
joint, because in disease of the hip joint the patient frequently 
complains of pain in the cutaneous area rather than in the 
joint where the actual disease is located. 

The Viscera. — The viscera are normally non-sensitive, 
i. e., Ave are not conscious of possessing viscera. The pressure 
of food in the stomach and the beat of the heart make no 
impression on our consciousness ; and so it is with all parts 
of the body governed by sympathetic nerves. The viscera are 
areas of low sensibility, not low irritability, for they are richly 
supplied with sensory nerves, upon the stimulation of which 
active functioning depends. The response to stimuli of sensory 
nerves in viscera is rapid, but normally this response takes 
place entirely outside of our consciousness, the impression is 
not recognized as coming from the viscera, but from a remote 
area of high sensibility in close central connection with the 
less sensitive area. As an example, pain is felt in the right 
shoulder, as a result of hyperaemia of the liver. The pres- 
sure upon sensory nerves in the liver does not cause pain in 
the liver, but refers it to a more sensitive area — the skin and 
muscles of the right shoulder. 

Chronic inflammation of the stomach mav cause no con- 



144 PRINCIPLES OF OSTEOPATHY. 

sciousness of pain in that organ, but may cause intense ach- 
ing in the mid-dorsal region. 

Nerves of Conscious Sensation. — Cerebro-spinalnerves 
are nerves of consciousness, and seem to have the duty of reg- 
istering on the sensorium of our brains not only their own im- 
pressions, but the impressions derived from that part of the 
sympathetic system in closest central connection with them. 

A close study of the segmental distribution of spinal 
nerves and their connection with the sympathetic system by 
the rami-communicantes will make Head's law of practical 
value in osteopathic diagnosis and therapeutics. 



CHAPTER VIII. 



SUBLUXATIONS. 

The word subluxation belongs most decidedly to osteo- 
pathic literature. No other system of therapeutics has taken 
any special notice of the effect of minor accidents on the os- 
seous and muscular structure of the body. It may be said 
that the seed from which the osteopathic system of therapeu- 
tics grew had for its germ cell a subluxation. 

Dr. Still tells us of his earnest thought and study of the 
skeleton of the human body. His mechanical brain could con- 
ceive of mechanical disorders in the body which must be 
treated mechanically in order to be corrected. Study and ex- 
perience combined to fix this idea more firmly and vividly 
in his brain. We can now see the great and lasting value of 
his basic idea that perfect structure is requisite for perfect 
function ; that there is no unused space in the body, hence a 
bone out of place must be occupying some other tissue's place ; 
that impingement of bone or other structural tissue on blood 
vessels and nerves results in perversion of the normal function 
of these obstructed media of exchange and communication. 



PRINCIPLES OF OSTEOPATHY. 145 

Definition. — The word subluxation was so new to the 
general medical profession that much ridicule was heaped upon 
the osteopaths because they advocated such a ridiculous theory 
as that "all diseases are caused by dislocation of bone." We 
are not so sure but that this ridicule was to a large extent well 
merited by the osteopaths. The loose way in which the words 
luxation, dislocation and subluxation are used in some of our 
literature shows that they do not always cover a definite idea 
in the mind of the writer. They can not be used interchange- 
ably. The word subluxation should be used to denote a def- 
inite pathological condition. Subluxation is defined as a par- 
tial dislocation in which the normal relations of the articu- 
lating surfaces are but slightly changed. 

Da Costa describes subluxation of the shoulder, also of 
the head of the radius. For the latter condition he has col- 
lected eight different explanations. We have not been able 
to find the term used in reference to any other articulations. 
The osteopath uses the term to define certain inequalities in 
the arrangement of vertebrae and ribs. Perhaps we hear the 
term used in connection with the atlas more than with any 
other bone. 

Diagnosis. — Subluxations allow considerable move- 
ment in the articulation, but to the trained hand there are evi- 
dences of malposition. Pain is developed when the complete 
normal movement is attempted by the operator. Digital pres- 
sure around the joint causes deep pain. There is usually a 
history of accident, exposure or visceral disorder. 

Primary or Secondary Lesions. — From experience we 
know the frequency of very evident malpositions of vertebrae, 
commonly spoken of as subluxations, and as being true or pri- 
mary lesions causing disordered function in the area of per- 
ipheral distribution of the nerves from that segment of the 
spinal cord. 

Analysis. — in order to get at a true understanding of 
what subluxation is we must make a careful study of the struc- 
tures which form a joint and their vital manifestations. 

The bones of the skeleton are bound together by liga- 
ments and muscles. The opposing surfaces of bones forming 



146 PRINCIPLES OF OSTEOPATHY. 

movable joints are covered with cartilage. The muscles exe- 
cute and the ligaments or soft parts around a joint limit the 
motions of the articulation. All moveable articulations have 
their bony parts maintained in their normal relations either 
by the form of the bones and cartilages attached to them or 
by the equal tension of all the controlling muscles. Enarthro- 
dial joints have freest movements and yet are the least de- 
pendent on muscles for retention of their normal position. 
Air pressure and the form of the bones are responsible for 
the integrity of these joints. These joints are less frequently 
subluxated than those possessing more limited motion. Ar- 
throdial joints depend upon the equal tension of their gov- 
erning muscles to keep the opposed surfaces in their proper 
relations. Co-ordination of the muscular tension is usually 
so perfect that the joint surfaces are perfectly opposed to 
each other. The disturbance of this nicely balanced muscular 
tension results in the drawing of one or both bony surfaces 
away from their true relations ; not entirely, but sufficiently 
to make it possible for the physician's fingers to note the 
change. 

Occipito-atlantal Articulation. — The; atlas is placed not 
only first in the vertebral column, but also first in importance 
to the osteopath on account of the great possibilities for slight 
displacement between it and the occiput. All the conditions 
are present which make a very moveable joint, and close at 
hand are important nerves and blood vessels whose slightest 
maladjustment causes instant disturbance at the very foun- 
tains of life. 

No physical examination is considered complete without 
noting accurately the position of the atlas. There being no 
spinous process, all reckoning must be made from the trans- 
verse processes. 

According to Gray's Anatomy: "The movements per- 
mitted in this joint are flexion and extension, which give rise 
to the ordinary forward and backward nodding of the head, 
besides slight lateral motion to one or the other side. * * 
* * The Recti Taterales are mainly concerned in the slight 



PRINCIPLES OF OSTEOPATHY. 147 

lateral movement. According to Cruveilhier there is a slight 
motion of rotation in the joint." 

According to Gerrish : * * * "Some lateral gliding 
is also allowed, by which the outer edge of the condyle on the 
one side is depressed, and on the other is elevated in relation 
to its socket. Or the movement may be obliquely lateral, one 
condyle advancing slightly at the same time that it is de- 
pressed toward the median line, while the opposite condyle 
takes the reverse position. This is the position of greatest 
stability, and is assumed in the most easy and natural atti- 
tudes. Lateral movements are restrained by the check liga- 
ments and the lateral parts of the capsules. No true rotation 
is allowed/' 

The capsular ligaments are very loose, hence the strength 
of the joint lies in the anterior, posterior and lateral ligaments. 
There is no cartilaginous disk between the atlas and occiput, 
hence motion is limited only by the ligaments named. 

If one should judge of the prevalence of dislocations of 
the atlas by the number of times such a condition is mentioned 
in osteopathic literature we would draw the conclusion that 
every one's atlas is dislocated. The term dislocation is a 
strong one, and ought not be used in connection with the atlas. 
Its dislocation would cause death instantly. Subluxation is 
the proper term to use. Subluxations can be readily diag- 
nosed ; the fact that they exist can not be doubted ; all posi- 
tions between the normal articulation and complete disloca- 
tion are possible. The complete dislocation of this bone from 
the occiput means death ; intermediate positions, subluxations, 
mean both irritation of nerves direct, and both direct and indi- 
rect disturbances of circulation ; direct disturbance by pressure 
exerted on arteries and veins, indirect disturbance by excitation 
of vaso motor nerves. 

The Causes of Subluxation. — It is difficult to account 
for these subluxations of the atlas without bringing in the 
contraction of muscles. This seems to me to be the most 
prevalent cause of misplacement of the atlas. Even though 
we recognize the numberless jars, twists and strains of this 
articulation, still the resultant bad effea > are maintained by 



i43 PRINCIPLES OF OSTEOPATHY. 

the unequal contraction of opposing groups of muscles which 
is brought on by these accidents. Take, for instance, the va- 
rious twists of the atlas found by osteopathic methods of 
physical diagnosis. Gray says : "The Recti Laterales are 
mainly concerned in the slight lateral movements." This is 
the movement concerned in a lateral subluxation. The posi- 
tion in which we usually find the atlas is an oblique one, hav- 
ing the right transverse process hugging the angle of the 
jaw while the left is too close to the mastoid process. 
Gerrish describes this position as the "obliquely lateral" a 
normal movement. We also consider it normal if it possesses 
the ability to slip back into a position having similar rela- 
tions on both sides. It is a subluxation when it can not get 
out of that position without assistance. If there is free move- 
ment in the occipito-atlantal articulation, every change of the 
position of the head will change the relations in this joint. 
Our bodies are constructed so that when the bones form- 
ing a joint are moved to their fullest extent pressure 
is usually exerted on soft tissues around the joint. This is 
normal, but when these normal relations are retained too long 
and the bones do not resume their easy resting position the 
condition becomes abnormal; it is then a subluxated joint. 

There is no articulation in the body whose bony parts 
are abnormally related when the extreme movement in the 
joint is made. We will except the sacro-iliac articulation, be- 
cause it is not considered a moveable joint. The subluxa- 
tion consists in the relation of the bony surfaces in a posi- 
tion other than that which they should hold during relaxa- 
tion or equal tension of all the muscles. The normal posi- 
tion of the transverse processes of the atlas is pictured in 
Fig 31. The subluxations are pictured in Fig 32. 

The normal relations of the atlas are illustrated by photo- 
graphs of the skull and first cervical vertebra in Fig. 33. Fig 
34 shows an oblique side view. In Fig. 35 the atlas is slightly 
twisted, so that the right transverse process is posterior. This 
rear view shows the distance between the left mastoid and 
left transverse process increased. The right transverse pro- 
cess is prominent. The same relations viewed from below are 



PRINCIPLES OF OSTEOPATHY. 




Fig- 3i. — Normal surface marking of the transverse process of the Atlas 



i5o 



PRINCIPLES OF OSTEOPATHY. 



shown in Fig. 36. The right transverse process is slightly 
posterior to the mastoid. 

Figs. 37 and 38 show side and lateral views of a twisted 
atlas. In preparing these bones for photographing, it has 

















Be! 


















■•» ^ 
















^C .^ a 



Fig. 32. — -Abnormal surface markings of the transverse process of the Atlas. 

been borne in mind that the articulating surfaces must be 
kept in close apposition. The relations illustrated are normal 
to the articulation, but abnormal when retained in these posi- 
tions after relaxation of opposing muscles. 



PRINCIPLES OF OSTEOPATHY. 



'5* 




Fig. 33- — Xormal relations between the Atlas and Occipital bone. 




Fig. 34. — Xormal relations between the Atlas and Occipital bone- 



152 



PRINCIPLES OF OSTEOPATHY. 



If, as Cruveilhier says, there is a slight rotation in 
this joint — and osteopathic practice proves Cruveilhier's state- 
ment true — ,then what muscle could by its persistent contrac- 
tion cause this rotation to be maintained? The Rectus Capi- 
tis Anticus Minor is so placed as to cause this movement. It 
arises from the anterior surface of the lateral mass and root 
of transverse process of the atlas and passes obliquely upward 
and inward. It is inserted into the basilar process of the oc- 
cipital bone. This muscle has as its external relation the supe- 
rior cervical ganglion of the sympathetic, and as a contracted 




Fig. 35- — Right transverse process of the Atlas too far posterior. 

muscle is thicker than an uncontracted one, pressure may be 
exerted on this ganglion which may also be irritated by the 
transverse process of the atlas being pulled toward it, thereby 
lessening its normal space in more than one direction. 

The reflexes originated by this irritation of the superior 
cervical ganglion or its connections may initiate changes in 
the caliber of the blood vessels of the brain, eyes or any other 
circulatory area under control of the ganglion. 

The influence exerted directly on circulation by the sub- 
luxation of the atlas is probably most active where the verte- 
bral arteries pass through the foramena in the transverse 



PRINCIPLES OF OS TEOPA TH Y. 



153 



processes. It might be argued against this view that nature 
has not failed to provide a certain amount of elasticity in the 
artery and surrounding structures to meet just such a condi- 
tion. Nature has certainly done this, but not with the idea 
in view that any such exaggerated condition is to be main- 
tained for any great length of time. 

Subluxations of the atlas are found in connection with 
a great number of disturbed areas, but the pathological con- 
dition in each is the same. For instance, there is no differ- 
ence between a hyperaemia in the nasal, pharyngeal or laryn- 




Fig. i>6- — Right transverse process of the Atlas too far posterior. 

geal mucosa and a congestion of the retina, except in loca- 
tion. We must not view retinitis as a distinct disease from 
laryngitis. If we should do so, we fix our attention on symp- 
toms and see a picture which conceals causes. When the 
superior cervical ganglion has its function of vasoconstric- 
tion inhibited by continued irritation, the work of maintain- 
ing vascular tone is passed along to peripherially placed gan- 
glia. If the eyes are strained by over work, the resistance 
of their nerves is decreased. This, added to the weakened 
vaso-constrictor action of the superior cervical ganglion, al- 
lows congestion, a retinitis. Wearing high collars weakens 



154 



PRINCIPLES OF OSTEOPATHY. 



the resistance of nerve endings in the skin of the neck. This, 
added to low power in the ganglionic station, leads to con- 
gestion in the pharynx or larynx. Treatment must be ap- 
plied to the structures around the ganglion, and peripheral 
nerve power increased by gradually exposing the skin to the 
atmosphere. 

The Atlas and Axis. — The articulation between the at- 
las and axis is the most intricate in the whole spinal column, 
consisting of four distinct joints. Rotation takes place be- 
tween these bones, but this motion is limited by the check 




Fig. 37- — Twisted Atlas-rotation. 



ligaments. Dislocation of the odontoid process causes instant 
death by pressure on the lower part of the medulla oblongata. 

The articulations between the articular processes of these 
bones are arthrodial. The articulation between the odontoid 
process of the axis and anterior arch of the atlas holds the 
bones firmly together. Most of the rotation in the cervical 
region is in this joint. Although there is so much movement 
allowed by these articulations we seldom find the axis sub- 
luxated. 

Unequal Development. — Deviation of the spine of the 



PRINCIPLES OF OSTEOPATHY. 



155 



axis from the median line is a frequent condition, but in the 
majority of cases is its normal relation on account of uneven 
development. 

Caries. — Hilton describes cases of disease of the artic- 
ulation between the atlas and axis, showing how destruction 
of the transverse ligaments allows the head to tip forward, 
thereby causing the odontoid process to impale the medulla. 

We may safely say that dislocation of the atlo-axial artic- 
ulations is probably the rarest condition we will ever meet. 




Fig- 38- — Twisted Atlas-rotation 



Various degrees of rotation may be met with which are in 
the nature of subluxations due to muscular contractions. 

Spontaneous Reduction. — Since the above paragraph 
was written, an article in the Medical Record, March third, 
1900, has come under my observation. The article is entitled, 
"Spinal Fracture — Paraplegia." The author, Dr. Robert 
Abbe, exhibits a radiograph illustrating a case of dislocation 
of the neck. The dislocation is between the articular pro- 
cesses of the atlas and axis. The most interesting feature 
of the case is the spontaneous reduction of .the dislocation 



156 PRINCIPLES OF OSTEOPATHY. 

while the patient was asleep. The author thinks that the relax- 
ation of sleep and the restlessness of the patient combined to 
reduce it. 

Cervical Vertebrae. — The remaining cervical. vertebrae 
are occasionally forced from their proper relations by vio- 
lence. Quite a number of cases are on record which show 
how great the disturbance is in such conditions. Those cases 
recorded in medical literature are complete dislocations, and 
hence can not be classed with subluxations such as are met 
with in osteopathic practice. In order for complete disloca- 
tion to take place, i. e., so that the articular processes are both 
locked, the intervertebral disks would have to be torn and 
would bring great pressure on the cord. 

All grades of subluxation are found between cervical ver- 
tebrae. Where the violence has not been sufficient to cause 
locking of the articular processes, it has exaggerated the nor- 
mal movement sufficiently to injure the ligaments or muscles, 
which therefore maintain the subluxated position. 

We can not estimate the extent of the systemic effects 
of a lesion in the spine. What might appear to us to be a 
very slight lesion, might be the cause of a very profound ner- 
vous disorder. The position of the lesion is the chief means 
of estimating results. 

To illustrate this point, we may mention the case of Mr. 
Norton Russell. A lesion of the sixth cervical vertebra was 
found. The vertebra was slightly twisted. Mr. Russell had 
not slept during one hundred nights and days without the 
use of sulphonol or morphine. The first osteopathic treat- 
ment applied to the sixth cervical vertebra made it difficult 
for him to keep awake until he reached his home, and then 
he feli into a profound sleep. There was a history of severe 
accident. Muscular contraction was very evident. 

Fig 39 illustrates the appearance of the posterior surfaces 
of the cervical vertebrae, second to the seventh, when all the 
vertebrae are in normal position, i. e., articular surfaces evenly 
opposed to each other. The changing character of the spinous 
processes is readily noted. Nearly all of these processes are 
unevenly developed, showing that palpation of these prom- 



PRINCIPLES OF OSTEOPATHY. 



157 



inent points can not help being unsatisfactory. The tubercles 
on the back and outer surfaces of the inferior articular pro- 
cesses present a much more uniform development and they 
can be easily palpated after one has become accustomed to 
the feel of the cervical muscles. 





Fig. 39- — Normal relations 
of the cervical vertebrae. 



Fig. 40. — Third cervical 
vertebra subluxated to 
the right. The superior 
articular process of the 
fourth cervical is vis- 
ible. 



Fig 40 shows the third cervical subluxated to the right. 
The tubercle on the left inferior articular process is made 
more prominent. The muscles over this point will be found 
contracted. 

Dorsal Vertebrae. — When the spines of the dorsal ver- 
tebrae are palpated, the trained fingers may find individual 
spines which are not in line with those above and below, or 
that the spacings between the spines is not equal. These de- 
viations from the normal are indicative of changed relations 
between the vertebrae. 

The normal movements in the dorsal region are flexion, 
extension and rotation. The lesions in this region correspond 
with these movements. 

False Lesions. — We must guard against being misled 
by the deviations which we find, especially lateral ones. Fig. 
41 illustrates a decided lateral inclination of the third dorsal 
spinous process. Such a deflection from the median line would 
be noted by the unskilled touch of a layman. This deflection 



158 



PRINCIPLES OF OSTEOPATHY. 



has no diagnostic significance, unless there is pronounced 
sensitiveness around it, and then it is the hyperaesthesia and 
not the osseous formation that must be noted. The most 
skillful osteopathic diagnostician would be misled by this 
lesion. There does not appear to be any way to protect against 
a wrong interpretation in a case like this except the experi- 
ence of the physician in weighing all the evidence. 




Fig. 41 



-Abnormal development of the spinous process of the third dorsal vertebra. 
A False L,esion. 



Lateral Subluxation. — Fig. 42 illustrates a genuine lat- 
eral subluxation of a dorsal vertebra. The arrangement of 
the Rotatores Spinae accounts for such a lesion as this. They 
arise from the upper surfaces of the transverse processes and 
insert into the laminae above. The subluxated vertebra in 
this group is the fifth. The digitition of the Rotatores Spinae 
between the right transverse process and lamina of the sev- 
enth must contract in order to produce this condition. This 
digitation may respond to a severe visceral reflex and cause 
a subluxation of this character. Direct violence may cause 
it, also a cutaneous reflex iniated by temperature change in 
the atmosphere. 

Muscular Contraction. — Muscles contract as a result 
of excessive straining or wrenching, or exposure to cold and 
of reflex irritation. If opposing muscles under all condi- 



PRINCIPLES OF OS TEOPA TH Y. 



159 



tions of temperature, mechanical and reflex irritation would 
continue to exert equal influence on a joint, then nothing but 
a complete dislocation would be possible. A moveable joint 
contains a synovial membrane which facilitates the rapid re- 
turn to a normal position. All the mechanical conditions in 
and around a joint are conducive to the quick return to nor- 
mal. It is the vital and not the mechanical principle which 
keeps up a condition of maladjustment. No intermediate po- 




Fig. 42. — Lateral subluxation of a dorsal vertebra. 

sition is possible, there being no unevenness of surface to 
become locked, unless we take into consideration the vital 
activity as manifested in a contracted muscle. 

Comparison of Effects of Muscular Contraction. — J. E. 
Stuart, D. O., has made an apt comparison between the pull 
of the muscles of the back on the individual vertebrae and 
the well recognized insufficiencies of the ocular muscles. All 
physicians recognize the serious effects of long continued in- 
sufficiency of an ocular muscle, but few, indeed, have given 
any thought to the possibility of a similar condition affect- 
ing structures less moveable or less sensitive than the eye ball. 
The relation of a vertebra with its fellows is of great im- 
portance to the delicate nervous tissue which it surrounds. 
It is not necessary for a vertebra to press upon the spinal 
cord or nerve fibers coming from or going to it in order to 
produce irritation. There is a nerve strain in connection with 
these lesions which is not the result of direct pressure, but of 



i6o 



PRINCIPLES OF OSTEOPATHY. 



the efforts of the central nervous system to balance and co- 
ordinate the contraction of the muscles pulling on the vertebra. 
It is not necessary for divergent or convergent squint to be 
so marked that the expression of the eyes is instantly noted 
by all observers before any symptoms of eye strain are felt 
by the patient. Neither is it necessary for a vertebra to be 
dislocated in order to create a disturbance. It is conceivable 
that a completely dislocated vertebra might, after a time, cause 
as little irritation as an eyeball which is so divergent that no 
effort is made to use binocular vision. The body becomes 
accommodated to the change. 




Fig. 43. — Flexion in the 
dorsal region showing 
spinous processes sepa- 
rated and superior ar- 
ticular processes par- 
tially uncovered. 




Fig. 44. — Lateral view of same 
condition as Fig. 43. 



Separation of Spinous Processes. — Figs. 43 and 44 give 
two views of the fifth, sixth and seventh vertebrae, illustrat- 
ing the separation of the spines as in extreme flexion. Note 
that the superior articular facets are uncovered by the move- 
ment. The vertebrae assume this position in kyphosis. We 
find frequently that there is a gap between two spines while 
the spacing above and below is quite even. Either the space 
directly above or that below this gap is lessened. Fig. 45 
shows the spines of the fifth, sixth and seventh dorsal ver- 
tebrae in the position of extreme extension. The spines crowd 
hard upon each other. These illustrations all show normal 



PRINCIPLES OF OSTEOPATHY. 



161 



positions, but they are the ones which our ringers discover 
as lesions of the vertebrae. 

Approximation of Spinous Processes. — When two 
spines are closely approximated, as in Fig. 45, there is nec- 
essarily a widening of the next space above or below, accord- 
ing to which vertebra is affected. The contracted space will 
usually be sensitive to digital pressure. There is a contract- 
ured condition of the muscles causing this extreme movement 
of extension. This contracture disturbs the rhythm of nerve 
impulses from that section of the spinal cord in closest rela- 
tion with the disturbed vertebra. There is a lack of co-ordi- 




Fig. 45. — Extension in the dorsal region showing approxima- 
tion of the spinous processes. 



nation of movement in the affected joints. When several 
vertebrae are tightly bound together, a straight, nonflexible 
spinal column is the result. The muscles are tightly contracted 
and more or less sensitive to digital pressure. 

Subluxations — Primary. — These conditions as here il- 
lustrated are what osteopaths usually designate as spinal sub- 
luxations which are causative factors in disease. They are 
sources of irritation to the spinal nerves in direct central ref- 
lation with them, and these nerves convey disturbed or ar- 
rythmical impulses to the viscera and blood vessels, thus caus- 
ing the various perversions of function which are recognized 
as symptoms of disease. 



l62 



PRINCIPLES OF OSTEOPATHY. 



Subluxations — Secondary. — These lesions must also be 
recognized as structural changes resulting from excessive, irri- 
tation to the peripheral end of sensory nerves, either those 
ending in skin and subject to the temperature changes, or 
those ending in the visceral mucosa and subject to irritation 
from the presence of food of an indigestible character, prod- 
ucts of fermentation, etc. We must recognize the fact that 
sensory nerves are subject to excessive stimulation in cases 
of gluttony or masturbation. Both of these bad habits may 
result from the stimulation of a spinal lesion, but experience 





Fig. 46. — Posterior view of five 
lower dorsal vertebrae, nor- 
mal relations. 



Fig. 47. — Side view of five lower 
dorsal vertebrae, normal rela- 
tions. 



with humanity teaches the physician that mankind in general 
delights in gratifying the senses. We do not wish to place 
spinal lesions at the bottom of man's moral weaknesses. 

Limited Area for Lateral Subluxations. — Lateral sub- 
luxations may exist as low as the tenth dorsal spine. The 
articular processes of the eleventh and twelfth dorsal verte- 
brae take on the character of the lumbar, hence rotation is 
practically impossible. There is a digitation of the Rotatores 
Spinae between the eleventh and twelfth dorsal vertebrae. 



PRINCIPLES OF OSTEOPATHY. 



163 



Characteristics of the Eighth, Ninth, Tenth, Eleventh 
and Twelfth Dorsal Vertebrae. — Figs. 46 and 47 give a pos- 
terior and lateral view of the five lower dorsal vertebrae. The 
/changing characteristics of the spinous processes of these ver- 
tebrae should be carefully noted, so that the student may not 
be misled as to the significance of that which his palpation may 




Fig. 48. — Dorso-lumbar kyphosis. The patient is sitting as erect as possible. 

discover. The eleventh dorsal spine takes a horizontal direc- 
tion, and in some cases this makes either a very narrow space 
between it and the tenth or a very wide space between it and 
the twelfth. 

Dorso-lumbar Articulation. — The junction of the dor- 
sal and lumbar regions is very flexible. A large portion of 
flexion and extension of the spinal column is made in this 
articulation. The most common condition noticeable in the 



1 64 



PRINCIPLES OF OSTEOPATHY. 



lower dorsal region is increased prominence of the spines, and 
incipient kyphosis. This condition frequently affects the junc- 
tion of the dorsal and lumbar regions, as in Fig 48. 

Kyphosis — Lower Dorsal. — A slight kyphosis in the 
lower dorsal region is indicative of loss of tone in the extensor 
muscles governing the articular surfaces. The spines are sep- 
arated farther than normal and the inferior articulating sur- 
faces are partly uncovered by the superior ones. See Fig. 48. 





Fig. 49. — Lumbar region, 
normal. 



Side view- 



Fis. 



-Lumbar region. Rear 
view — normal. 



This weakened condition of the back may be brought on by 
injury, or reflexes from the bowels or kidneys. Continual vi- 
bration of the spinal column, as in cases of street car men, 
weaken the back, and then functional disturbances of the kid- 
neys are noted. 

Lumbar Region. — Figs. 49 and 50 illustrate the lateral 
and posterior appearance of the normal lumbar vertebrae. The 
spinous processes are easily palpated in this region. Their 
development varies enormously in different individuals. The 
formation of the articular processes prevents any rotation, 



PRINCIPLES OF OSTEOPATHY. 165 

hence we do not find any lateral subluxations in this region. 
The position of individual vertebrae is rarely affected. 
"Breaks," that is, separations of the spines, are sometimes 
noted, but not often. Violence is the chief cause of these sep- 
arations. The muscles in this region are thick and powerful, 
hence their influence is not exerted so much on individual ver- 
tebrae as upon the whole series of vertebrae. Therefore we 
find curves instead of subluxations in this region. Exagger- 
ation of the normal movements is responsible for kyphosis, 
lordosis or scoliosis. Extreme weariness as a result of main- 
taining a sitting or standing position leads the individual to 
shift the weight of the body so as to take some advantage of 
the ligaments which limit a movement. 

The strength and flexibility of the lumbar region is fre- 
quently a very good criterion of the patient's bodily vigor. It 
is easier to affect this portion of the spinal column by lever- 
age movements than any other region. 

Examination of the Ribs. — The position of the ribs is 
always noted by the osteopathic physician. It is noted in 
medical text-books on diagnosis that the general conforma- 
tion of the thorax is indicative, to a variable degree, of either 
the past medical history of the individual or is evidence of 
the present existence or predisposition to certain diseases. A 
full, round, nonflexible chest denotes asthma or emphysema; 
flat chest denotes tendency to tuberculosis, etc. These state- 
ments are generalizations based on long observation, and are 
usually very near the truth. The respiratory movements should 
be noted, whether full and free compared with the capacity of 
the thorax. 

The osteopathic physician goes farther than these excel- 
lent generalizations in his diagnosis. The relation and po- 
sition of each individual rib are extremely important. The con- 
dition of the whole thorax, and its contents, is dependent on 
the relations of the bones which form it. With this idea in 
mind, a careful examination of each rib is made. 

The ribs are, normally, quite moveable. Their spinal 
articulations are so arranged that an easy rise and fall of the 
shaft of the rib is permitted. The rise and fall is the result 



1 66 



PRINCIPLES OF OSTEOPATHY. 



of rotation of the rib on an axis passing through the costo- 
central and costo-transverse articulations. 

Costo-central Articulations. — The costo-central articu- 
lations of the first, tenth, eleventh and twelfth ribs have no 
interarticular ligament. The movement of the heads of these 
ribs is limited by the capsular ligament. The heads of all the 
other ribs are held in place by interarticular ligaments attached 
to ridges on the heads of the ribs and to the intervertebral 
disks. 

Costo-transverse Articulations. — The tubercles of the 
ribs articulate with the transverse processes of the vertebrae 




Fig. 51. — Norrrtal relations of the fifth and sixth ribs. 



forming arthrodial joints. The superior costro-transverse lig- 
aments prevent the dropping down of the costro-transverse 
articulation. There is very limited gliding movement in this 
articulation. As before stated, the movement in the costro- 
central and costro-transverse articulations is rotation. The 
shaft of the rib lies obliquely downward, therefore the rota- 
tion of the rib during inspiration turns the anterior extremity 
upward and outward. The axis of the rotation through the 
costro-vertebral articulations is obliquely downward, there- 
fore the lateral position of the shaft of the rib is elevated dur- 
ing inspiration and the lower border is turned outward. 

Co-ordination. — Fig. 51 illustrates the normal obliquity 
of the fifth and sixth ribs. When the contraction of all the 






PRINCIPLES OF OSTEOPATHY. 167 



muscles of respiration is properly co-ordinated, the intercostal 
spaces are all equal in width. The respiratory rhythm should 
be equal in all parts of the thorax. 

When through some nervous reflex, inspiration is made 
difficult, the inspiratory muscles expand the thorax to its fullest 
extent and retain the expansion. Then the diameters of the 
thorax are increased. This position of extreme inspiration is 
typical of the asthmatic chest. 

Inco-ordination. — There may be lack of co-ordination 
of the muscles in any intercostal space. This inco-ordination 
may be manifested by too much contraction or relaxation. The 
result is a change in the normal width of an intercostal space. 

Nervous Control of Respiration. — Respiration is carried 
on by a complicated mechanism. Its chief center of normal 
control is in the medulla, but subsidiary centers in linear series 
exist in the spinal cord. Each spinal nerve which innervates 
intercostal muscles or other muscles of inspiration arises from 
a subsidiary respiratory center. One of these subsidiary cen- 
ters may become too active or passive as a result of local irri- 
tation, due to circulatory changes. The muscles governed by 
this disturbed center will not act harmoniously, hence the 
rhythmical movement of all the ribs is interfered with. 

We have noted that spinal muscles contract unevenly as a 
result of direct spinal injury, exposure of the skin over them to 
cold, or from visceral reflexes. The respiratory muscles are 
subjected to the same conditions. A lateral subluxation in the 
dorsal region carries its articulated rib with it. Palpation will 
discover their changed relations. A kyphosis in the dorsal 
region causes the ribs to rotate upwards, thus increasing the 
diameters of the thorax. Lordosis in this region has the op- 
posite effect. 

Costal Subluxations. — Figs. 52 and 53 illustrate the 
changes in spacing of the ribs due to inco-ordination of mus- 
cular contraction. These positions of the ribs are spoken of as 
costal subluxations. In Fig. 52 the upper rib is rotated down- 
ward as a result of a contraction of the intercostal muscles of 
the space below it or the relaxation of those above it. Palpa- 
tion elicits sensitiveness at the lower border of this fifth rib. 



1 68 



PRINCIPLES OF OSTEOPATHY. 



The sensitiveness is usually found where there is compression 
due to the dropping of the rib and the contraction of the 
muscles. This rib might have become displaced as a result 
of violence, or the patient might have been exposed to cold 
air while sweaty, or some disease of another part of the body 
might have caused sufficient weakness to allow this rib to drop 
as a result of pressure occasioned by the position in bed or 
otherwise. 

Whatever the cause of these subluxations, they certainly 
become sources of great irritation to the nervous system. Some- 
times the body becomes accommodated to these subluxations, 




Fig. 52. — Approximation of the fifth and sixth ribs. 



but the fact that cases of asthma have been cured, after years 
of suffering, by reducing these malpositions is prima facie evi- 
dence that accommodation is something that can not always be 
depended on. 

The heads of the second to ninth ribs cannot be dislocated 
without rupture of the interarticular ligaments. Considerable 
change in the position of the shaft of the rib occasions very 
little change in the position of the head of the rib. 

First Rib. — The first rib does not move in the same 
manner as those below. The attachment of the scalenus an- 
ticus keeps the shaft always raised. No matter how flat the 
remainder of the thorax may be, the first rib stands out promi- 



PRINCIPLES OF OSTEOPATHY. 169 

nentlv. The chief change in its position is cine to the con- 
traction of the scalenus anticus, therefore it needs to be de- 
pressed rather than elevated. 

Tenth Rib. — The head of the tenth rib is articulated 
with the body of the tenth vertebra, there is no interarticular 
ligament. This allows freer movement. Its anterior extrem- 
ity is insecurely articulated to the cartilage of the ninth rib. 
This connection is frequently broken, thus making an added 
floating rib. 

Eleventh and Twelfth Ribs. — The eleventh and 
twelfth ribs are very loosely articulated to the vertebrae. They 













S./ 




■ ': . ■ .. 



F'S- 53- — Separation of the fifth and sixth ribs. 



have no costotransverse ligaments, hence depend on the action 
of muscles to hold them in place. They are frequently found 
rotated upward or downward. 

We have endeavored to show that the normal movements 
of the ribs as a whole may become very abnormal when made 
individually or out of rhythm with each other. The depres- 
sions or elevations of individual ribs have not dislocated their 
articulations ; they have merely carried and retained them in 
positions out of harmony with the remainder of the ribs. They 
have become discordant members of a harmonious body, and 
unless made to co-operate for the general welfare, they will 
rapidly make other members inharmonious. 



170 



PRINCIPLES OF OSTEOPATHY. 




Fig. S4- — Normal surface markings of the relations of the sacrum and ilia. 



PRINCIPLES OF OSTEOPATHY. 



171 



Effect of Position of Vertebrae on Position of Ribs. — 

Lack of symmetry in the dorsal vertebrae causes a change in 
the position of the ribs. Both conditions can be corrected by 
reduction of the vertebral subluxations. 

Clavicles. — The clavicles may be elevated or depressed 
by muscular contraction. Their depression affects the vessels 
crossing the first rib to and from the upper extremity. The 
subclavius muscle is responsible for depression of the clavicle. 




Pig- 55- — .Normal relations of sacrum and ilium. 



Sacro-iliac Articulation. — The articulation between the 
sacrum and the ilium is variously described. Some claim it 
has a synovial membrane ; others deny it. It may be that age 
and sex have much to do with this question. Ordinarily there 
is no movement in this articulation. It serves the same pur- 
pose for the pelvis as the cranial sutures do for the head, that 
is, to minimize shocks. The articular surfaces of the sacrum 
and ilium are covered with cartilage, the ligaments are strong, 
muscular contraction has no effect on their relative positions, 
nothing but a very severe shock could displace them. 



172 PRINCIPLES OF OSTEOPATHY. 



Fig. 56. — Upward and forward dislocation of the right ilium. 



PRINCIPLES OF OSTEOPATHY. 



73 



According to the above facts and our definition of the 
term subluxation, nothing but a dislocation can take place in 
this joint. There is no normal movement, hence any change 
in the relation of surfaces is a dislocation. Whenever the ilium 
is found raised above its normal relations with the sacrum, the 
patient will give a history of accident. 

Fig. 54 illustrates the osseous relations on the posterior 
surface of this articulation. Normally the posterior superior 
spines of the ilia are on a horizontal line running through the 




Fig. 57. — Ilium forced upward and forward. 



second sacral spine. The crests of the ilia are on a level with 
the fourth lumbar spine. Fig 55 shows these bones in their 
normal relations. 

The Nerves Affected. — The structures which are quite 
liable to irritation by dislocation of the ilium, are the nerves 
passing out and in through the great and lesser sacro sciatic 
foramena; also the lumbar nerves in relation with the psoas 
magnus muscle. 

Symptoms. — From the symptoms complained of in 



174 



PRINCIPLES OF OSTEOPATHY. 



five cases observed by the author, we note the following : first, 
a soreness on the bruised part, which soon ceases to attract 
attention, then pains in the extremity resembling rheumatism ; 
about this time the patient seeks relief, is treated by the ordi- 
nary drug methods with no success. During these months of 
drug treatment the hip rotators begin to contract and stiffen 
the joint. Within eighteen months after the accident the hip 




Fig. 58. — Ilium forced upward and backward. 



joint has lost its function. It always becomes fixed in the 
extended position. Pain is practically constant. 

Physical examination showed the relations pictured in 
Fig. 56. The crest and superior posterior spine of the ilium 
were above their normal relations. The leg on the injured side 
was shortened. These five case presented almost exactly the 
same symptoms. The upward and backward position of the 
ilium is illustrated in Figs. 58 and 59. 

The shape of the great sacro- sciatic foramen is changed. 

Fig. 57 illustrates an upward and forward position of the 
ilium. The obliquity of the pelvis at the time of the acci- 
dent has much to do with the direction in which the luxation 



PRINCIPLES OF OSTEOPATHY. 175 

takes place. When the luxation is caused by a severe shock 
on the posterior surface of the tuber ischii, the ilium is twisted 
and the superior posterior spine is very prominent, but below 
the level of the second sacral spine. In one case examined the pa- 
tient was jolted out of a spring seat and struck on the tire of the 
wagon wheel. The above described position of the ilium re- 
sulted. Fie. 60 gives the surface indications. 



Fig- 59- — Posterior superior spine of the ilium is too prominent. 

Hypersensitiveness will be found internal to the posterior 
superior spine of the ilium, center of the crest of the ilium 
and over the crest of the pubes. 

Fig. 61 is a drawing from an X-ray photograph of a lux- 
ated left ilium. Quite a number of cases of luxated ilia have 
been reported in osteopathic literature. The reports are fa- 
vorable. We are compelled to report unfavorably on all cases 
we have seen. This is a serious luxation, and one not easily 
reduced. None of my cases were examined osteopathically 
until after a lapse of two years. During these two years move- 
ment in the hip was lost and the ilia became absolutely fixed. 



176 



PRINCIPLES OF OSTEOPATHY. 




Fig. 60. — Posterior superior spine of the ilium is prominent 'and slightly below 
the second sacral spine. 



PRINCIPLES 


OF OSTEOPATHY. 


177 




In one case sufficient force 


was us 


?d to move the 


ilium, but 




it could not be forced into its normal 


position 


Pain was greatly 




relieved in all cases. 












Sacro-vertebral Articulation 


—The 


articulation be 




tween the sacrum and fifth lumbar 


is one w 


Kich is 


subject to 






3 








. i 

| 




2 










4 








4 




10 


1 




10 






5 








5 


11 
7 




7 


5 






6 






9 






9 








6 




6 










. 



Fig. 6i. — Dislocation of left ilium upward and backward. i, Sacrum; 2, 5th 
Lumbar Vertebra; 3, 4th Lumbar Vertebra; 4, 4, Illiac Fossae: 5, 5, Head of 
Femur; 6, 6, Lesser Trochanter of Femur; 7, 7, Pubes; 8, 8, Obturator Fora- 
men; 9, 9, Tuberosity of Ischium; 10, 10, Greater Sacro-sciatic Foramen; 11, 
Spine of Ischium. 



great strain. The thick cartilage between the bodies of these 
bones allows considerable compression and thereby preserves 
the articulation from harm. It is not uncommon to find the 
fifth lumbar forced too far anterior by the obliquity of the 
sacrum. This articulation seems to be the one principally con- 
cerned in lordosis of the lumbar region. In connection with 
this malposition we find pelvic disorders resulting from irri- 



178 PRINCIPLES OF OSTEOPATHY. 

tation of the hypogastric plexus situated on the anterior sur- 
face of this vertebra. 

Every individual has his or her particular develop- 
ment. When examining patients this must be taken into 
consideration. All subluxations must be judged according to 
the condition of the reflexes along the nerve tracts which they 
might influence. 

Summary. — A subluxation is evidence of unequal ac- 
tivity of opposing muscles, caused by twist, strain, fall, ther- 
mal change or reflex irritation from viscera. It is an evidence 
of vital activity unevenly manifested. The mechanical condi- 
tion which we call a lesion may be only evidence of a lesion 
which lies in the excessively active muscle or at some other 
point in close nervous connection. 

A subluxation may be called a primary lesion when it re- 
sults from accident. It is secondary when due to reflex ac- 
tion. It is not always possible to determine whether a lesion 
is primary or secondary, but in general it is best to reduce 
them wherever found if any disturbance can be traced to 
them. 

In rare instances one treatment has been found sufficient 
to reduce a subluxation. The fact that the majority of cases 
must be treated two or three months proves that they are not 
easily kept reduced. 



CHAPTER IX. 



OSTEOPATHIC CENTERS. 

Certain points on the surface of the body are spoken of 
as "Centers." This word has become a part of the osteopath's 
technical vocabulary. It does not convey to the mind of the 
osteopath the same meaning which attaches to it when used 
in physiological text-books. 

A physiological functional center in the central nervous 
system is that point where the action of a certain viscus or 
other structure is governed. 

An osteopathic center is that point, on the surface of the 



PRINCIPLES OF OSTEOPATHY. 179 

bodx which has been demonstrated to be in closest central con- 
nection with a physiological center, or over the course of a 
governing nerve bundle. 

In Chapter III, under the sub-heading Segmentation, ref- 
erence is made to the division of the central nervous system into 
sections which may, to a moderate degree, functionate inde- 
pendently. No portion of the nervous system ever function- 
ates absolutely independently. The action of every portion af- 
fects all other portions, but certain areas in the brain and 
spinal cord seem to be somewhat set apart to govern or co- 
ordinate the physiological activity of certain organs. Physi- 
ology has demonstrated a large number of these centers. 

"Physiology shows how not only the individual ganglia 
which lie in the intestines function with relative independence, 
but how even structures like the spinal ganglia frequently reck- 
oned in with the central system still enjoy relative indepen- 
dence from it functionally." 

"What we know of the anatomical structure and of the 
functions of the central nervous system of vertebrates forces 
us more and more to the conclusions (1) that even individual 
parts of the central system are themselves in a position to 
function to a certain extent independantly, and (2) that even the 
brain and spinal cord of vertebrates are composed of a series of 
centers. Whether the one or the other of these is more highly 
developed, whether they are in connection with deeper centers, 
whether they have connections among themselves and with 
higher centers, determine the measure of the higher or lower 
development of the central system. We will find later that, 
in the course of the development of a class, individual centers 
connected with the central nervous system have reached a high 
development, while others have arrived at a certain stage (or 
reached a certain type) where they remain stationary, and 
throughout all subsequent posterity remain everywhere alike. 

"One can conceive that in its essentials every nervous 
system is composed of afferent tracts and efferent tracts, and 
of tracts which form the connection of the elements among 
themselves." (Anatomy of the Central Nervous System of 
Man and of Vertebrates in General. Edinger, page 26.) 



180 PRINCIPLES OF OSTEOPATHY. 

Anatomy and Physiology demonstrate that from a cer- 
tain segment of the spinal cord nerve fibres are distributed 
to skin, skeletal muscles, involuntary muscles and mucous 
membrane of viscera, and to the muscular coats of the arteries 
supplying all these structures. 

Physiology and Pathology demonstrate that impressions 
made upon sensory elements in skin, mucous membrane, mus- 
cle, or other structures, are carried to a center in the central 
nervous system. These impressions are co-ordinated in this 
center, and affect the physiological action of all structures in- 
nervated from the same center. When we speak of two or 
more structures being in close central connection, we mean 
that they are innervated from the same segment of the central 
nervous system. 

Diagnosis. — In diagnosis these segments serve the pur- 
pose of calling the osteopath's attention to the condition of 
several correlated structures. For example : A hyperesthe- 
sia at any point along the spinal column fixes the attention of 
the osteopath upon all the structures of the body which are 
innervated from the segment of the central nervous system 
which furnishes nerves for this over-sensitive area. Exami- 
nation of all the structures thus supplied will probably dis- 
cover the point chiefly affected. 

In order to give the student a clear insight into the prin- 
ciples underlying osteopathic diagnosis, we will examine the 
osteopathic centers serially, commencing at the atlas. 

First Four Cervical Nerves. — We will first divide the 
spinal column into sections according to the location of certain 
groups of nerves. Remember that these divisions are made 
with reference to the points of exit of the spinal nerves from 
the spinal column. 

The first section contains the first four cervical nerves. 
The first cervical nerve leaves the spinal canal between the 
occipital bone and the atlas. A study of its distribution will 
inform us what structures are governed by it. Its anterior di- 
vision forms a part of the cervical plexus. This division com- 
municates with the sympathetic nerves on the vertebral artery, 
the pneumogastric, the hypoglossal, and superior cervical sym- 



PRINCIPLES OF OSTEOPATHY. 181 

pathetic ganglion. It innervates the Rectus Lateralis and An- 
terior Recti. 

The posterior division of the first cervical nerve is called 
the suboccipital. It supplies motor fibres to the posterior Recti 
muscles of the head, the Superior and Inferior Oblique, and 
the Complexus. Sensory fibres from the scalp form part of 
this nerve. 

Example of Hilton's Law. — With this outline of dis- 
tribution before us, we can note some of the results of stim- 
ulation of this nerve. Since the anterior division supplies a 
few fibres to the occipito-atlantal articulation, we have an ex- 
ample of Hilton's law of distribution of a nerve trunk. The 
synovial membrane of the occipito-atlantal articulation, the 
muscles which govern movements of the joint, and the skin 
over the joint are all innervated by this first cervical nerve. 

The muscles moving the occipito-atlantal articulation act 
according to impulses reaching the point of origin of the first 
cervical nerve over sensory fibres ending in the skin covering 
the back of the head and this articulation, also from those 
ending in the synovial membrane of the joint. These im- 
pulses are co-ordinated in higher centers of the brain which 
govern equilibration. The muscles of this joint act also accord- 
ing to our will. 

The Pneumogastric Nerve. — Furthermore, the anterior 
division of this nerve communicates with the pneumogastric, 
hypoglossal, and the superior sympathetic ganglion. The 
pneumogastric has such a wide distribution that we cannot 
afford to follow all of its paths of influence at this time. The 
student is referred to any extended work on anatomy for the 
details. The muscles and mucous membranes of the larynx 
are innervated by the pneumogastric, hence any irritation of 
the larynx may reflex impulses to the center of origin of the 
first cervical nerve and cause undue contraction of the mus- 
cles innervated by it. This muscular contraction can result in 
changing the relation of the bones forming the occipito-atlantal 
articulation until a condition exists which we call a sublux- 
ation of the atlas. Having followed the impulses from the lar- 
ynx to the center of co-ordination and out again to the mus- 



i82 PRINCIPLES OF OSTEOPATHY. 

cles of the occipito-atlantal articulation with consequent sub- 
luxation, we may profitably note the fact that sudden temper- 
ature changes may affect the skin over these muscles, arousing 
impulses which are carried to the center of co-ordination, 
thence to the muscles, causing them to contract with result- 
ing subluxation. Some of the reflex impulses may find their 
way to the larynx and cause congestion of its mucosa. The 
atlas may be subluxated by violence, then the sensory impulses 
originate in the synovial membrane of the joint and in the 
muscles moving the joint. These impulses may be reflected 
in such manner as to affect the larynx, pharynx and other 
structures innervated by the pneumogastric. The reflex in- 
fluences existing between the first cervical nerves and the 
pneumogastric are chiefly confined to the larynx and pharynx, 
because spinal nerves usually receive sympathetic reflexes from 
the segment of the body which they cover. If we should fol- 
low all of the divisions of the pneumogastrics, we would find 
a wonderful diversity of distribution. We do not expect that 
reflexes from the heart, lungs, stomach, etc., are going to be 
subject to co-ordination in the area of origin of the first cerv- 
ical nerve, just because there is communication between the 
pneumogastric and this nerve. The pharynx and larynx are, 
in part, structures governed involuntarily, and hence they are 
in large part removed from the influence of nerves carrying 
voluntary impulses, i. e., spinal nerves. The pneumogastric is 
essentially sympathetic in character. The tissues of the lar- 
ynx and pharynx are practically under the influence of the 
first cervical nerve. Your attention is called to Hilton's law 
as he has stated it in relation to mucous and serous surfaces. 
"This same principle of arrangement, anatomically, physio- 
logically and pathologically considered, is to be observed, with 
an equal degree of accuracy in the serous and the mucous mem- 
branes. Thus considered, it presents a principle which, if it 
has any application in practice, must be one certainly of large 
extent." 

Since the spinal accessory forms part of the pneumo- 
gastric above the point of communication between that nerve 
and the first cervical, we can perceive the reason for the great 



PRINCIPLES OF OSTEOPATHY. 183 

influence which temperature changes, affecting the skin over 
the sterno-cleido-mastoid and trapezius muscles, have on the 
action of the muscles forming the suboccipital triangles. The 
spinal accessory innervates the sterno-cleido-mastoid and tra- 
pezius. These muscles will contract reflexly when the sensory 
nerves in the skin over them are affected by temperature 
changes. The action of these muscles affects the position of 
the head chiefly by causing movement in the occipito-atlantal 
articulation whose accurate adjustment depends on the mus- 
cles innervated by the first cervical nerves. 

The point of origin of the first two cervical nerves is prob- 
ably a bilateral center. In order to secure co-ordinated move- 
ments, both sides of this bilateral center must act recipro- 
cally, but if the impulses coming into the center from one side 
are much greater in number and intensity than those enter- 
ing on the opposite side, this reciprocity of action may be in- 
terfered with and subluxation result. 

The Hypoglossal Nerve. — The Hypoglossal nerve is 
the motor nerve to the muscles of the tongue, and to the mus- 
cles moving the larynx and hyoid bone. It communicates with 
the first cervical nerve. Movement in the occipito-atlantal ar- 
ticulation affects the relations of the points of origin and in- 
sertion of the muscles innervated by the hypoglossal ; there- 
fore, impulses passing over both nerves are co-ordinated at 
about the same area. 

Superior Cervical Ganglion. — Probably the greatest 
cause for disturbance along the course of the first cervical 
nerve is the communication with the superior cervical gan- 
glion and the sympathetic plexus on the vertebral artery. This 
communication subjects all the structures innervated by the 
first cervical to reflexes initiated in various areas of the head, 
neck and brain. 

The superior cervical sympathetic ganglion has a vaso- 
constrictor influence over the blood vessels of the head, neck 
and brain. It is a well known clinical fact that ice applied to 
the surface of the neck over the occipito-atlantal articulation 
will cause constriction of the blood vessels of the brain. This 
constriction is a reflex effect due to the communication of the 



i84 PRINCIPLES OF OSTEOPATHY. 

first cervical nerve with the superior cervical sympathetic 
ganglion. 

Suboccipital Triangles. — When the first cervical nerve 
is sensitive to moderate pressure over the suboccipital tri- 
angles, we may be sure that it is evidence of disturbance of 
circulation in some part of the head, neck or face. We look 
for this disturbance in the structures which are subjected to 
the greatest amount of work, i. e., the eye, pharynx or larynx. 
The brain, last, because it is not easily fatigued. . Sensitive- 
ness is nearly always associated with a subluxated atlas, i. e., 
one is indicative of the other. 

Whether the subluxation is primary or secondary, it is 
a source of irritation and must be reduced ; therefore, in prac- 
tice our treatment is applied primarily to this changed struct- 
ure. The results of practice prove this to be the best method. 

Patients rarely complain of sharp neuralgic pain in the 
area of the suboccipital triangles. A dull ache or tension is 
the usual subjective symptom. 

We have described the characteristics of this center with 
considerable detail in order that the student may understand 
how thoroughly an accurate knowledge of anatomy and phys- 
iology enters into the work of the osteopath. Every center 
must be understood in this same manner. We do not deem it 
necessary to go into such detail in describing all of the remain- 
ing centers in order that the student can understand their sig- 
nificance. 

In order to make the characteristics of the first cervical 
nerve stand out prominently, we have described it as though 
it were individual in its action and reaction. This is not strictly 
true. Analysis compels us to note ill-defined separations in 
the nervous system. In order to get a right conception, we 
must view the first cervical nerve as only one of a group of 
four cervical nerves which act in harmony. 

Cervical Plexus. — The first four cervical nerves are in- 
terwoven to form a plexus. Each distributive branch from 
this plexus probably contains some communicating fibres from 
the four primary nerve trunks. Viewing the plexus as a 
whole, we find that its branches are distributed according to 



PRINCIPLES OF OSTEOPATHY. 185 

Hilton's law. They innervate the skin of the neck as low as 
the fifth cervical spine posteriorly, then obliquely forward as 
low as the sterno-clavicular articulation anteriorly, and the 
acromio-clavicular articulation laterally. The skin of the pos- 
terior surface of the cranium and the ear receives sensory 
fibres from this plexus. These' are the gross points to be re- 
membered concerning cutaneous sensory distribution from this 
plexus. The muscles under this cutaneous area all receive mo- 
tor fibres from the first four cervical nerves. 

Anatomists divide the cervical nerves into anterior and 
posterior divisions, then describe these separately. This is an 
artificial division which does not serve any useful purpose for 
us. It multiplies detail without giving an adequate concep- 
tion of the real character of the whole nerve. When you study 
the ultimate distribution of the anterior division of a nerve 
forming the cervical plexus, do not fail to remember that the 
ultimate distribution of the posterior division is a part of the 
same nerve. If the anterior division communicates with a 
sympathetic ganglion, the posterior division receives impulses 
from and sends impulses to this ganglion. If the anterior di- 
vision communicates with the vagus and hypoglossal nerves, 
the posterior division is a party to this communication, and 
in all ways benefits or suffers by it according to the number 
and intensity of the stimuli applied at any point along the 
course of either nerve. 

This upper portion of the neck is the most flexible part 
of the whole spinal column. It is subjected to more changes 
of temperature and more strains or twists than other portions 
of the spine. The constant effort to save the head from injury 
puts a severe tax upon the activity of the muscles moving this 
portion of the spinal column. Subluxations of the atlas and 
third cervical are quite frequent. Muscular lesions, contrac- 
tions, are found here in connection with functional disorders 
of many kinds located in the brain, eyes, ears, nose, mouth 
or throat. Almost invariably a relaxation of these contrac- 
tions will be a necessary step in relieving disorders in the areas 
named. 

Intensity of Reflexes. — Individuals differ greatly in 



1 86 PRINCIPLES OF OSTEOPATHY. 

the intensity of their reflexes. Anatomatically considered, the 
connections between the sympathetic and cerebro-spinal sys- 
tems are alike in all individuals, but physiologically consid- 
ered, there is a vast difference in the degree of independent 
functioning of these systems. Patients will be found whose 
symptoms and lesions do not show any marked tendency to- 
ward reflexing impulses from one system to the other. The 
sympathetic nerve cells may be so vigorous that severe lesions 
affecting cerebro-spinal nerves do not in the least disturb the 
rhythm of the sympathetic system. Likewise severe func- 
tional disturbances may exist in the area of the sympathetic 
control without causing very definite conscious sensations. 

The Spinal Accessory. — The sterno-cleido-mastoid and 
trapezius muscles are innervated by the spinal accessory. This 
nerve arises from the spinal cord as low as the sixth cervical, 
therefore, its impulses are co-ordinated with the cervical plexus 
in the area of its normal control. 

The Phrenic Nerve — Hiccough. — The phrenic nerve is 
the motor nerve from the cervical plexus. It innervates the 
diaphragm. It is formed by branches of the third, fourth and 
fifth cervical nerves. The position of this nerve in its course 
along the anterior surface of the scalenus anticus, makes it 
convenient to apply direct inhibitory pressure over the nerve 
trunk. This pressure has a restraining influence over the im- 
pulses traveling to the diaphragm ; therefore, we inhibit to stop 
hiccough. We have treated cases in which inhibition was of 
no avail. In such cases a strong movement of the head and 
first three cervical vertebrae, as a solid lever, to secure rota- 
tion and relaxation between the third and fourth cervical verte- 
brae may give good results. Since hiccough is a reflex due 
to stimulation of sensory nerves, especially the pneumo- 
gastric, it should not be expected that inhibition of the motor 
nerve, phrenic, would entirely stop hiccoughs while the sen- 
sory stimulation is continued. Clinically, we find that inhi- 
bition of the phrenic nerve is sufficient to stop the ordinary case 
of hiccoughs. Therefore, we call the area over the course of 
the phrenic nerve, as it crosses the scalenus anticus muscle 



PRINCIPLES OF OSTEOPATHY. 187 

opposite the fifth cervical transverse process, the "center for 
hiccoughs.'' See Fig 165 

The Trapezius and Splenitis Capitis et Colli Muscles* 
The cervical plexus communicates with the brachial plexus ; 
therefore we expect that those large muscles, such as the tra- 
pezius and splenitis, which are innervated by nerves from seg- 
ments of the spinal cord, at various levels, will transmit by 
their action the influence reflexed to them at any point of their 
serial innervation. The spinal accessory innervates a large 
part of the cervical fibres of the trapezius. The third and 
fourth cervical nerves send branches to this muscle. There- 
fore any distrubance along the course of these nerves, or along 
the course of other nerves in close central connection with them 
which may cause abnormal contraction of the trapezius, will 
influence, more or less, all the points of attachment of that 
muscle. The trapezius is seldom abnormally contracted. Any 
lessening in the normal range of its action is quickly noted by 
the patient. The contractured condition is easily removed by 
a willed action. We use the trapezius muscle as a means of 
transmitting power to various portions of the spinal column, 
i. e., in our efforts to move one or more vertebrae. 

Vaso-motion, Head, Face and Neck. — The superior cer- 
vical ganglion communicates with the first four cervical nerves, 
therefore the area over the spines of the first four cervical ver- 
tebrae is called a vaso-motor center for the head, face and neck. 

Affections of the Cervical Nerves. — These upper cer- 
vical nerves are seldom paralyzed. Paralysis in this region 
would stop the action of the diaphragm. Neuralgia may af- 
fect the nerves of this group. Spasmodic contraction of the 
muscles innervated from this area is not uncommon. 

Brachial Plexus. — The four lower cervical nerves arise 
from the cervical enlargement of the cord and form the bra- 
chial plexus with their anterior divisions, while their posterior 
divisions supply motor fibres to muscles on the sides and back 
of the neck, and sensory fibres to the skin over these muscles. 
The anterior division of the first dorsal nerve forms a part 
of the brachial plexus. 



i88 



PRINCIPLES OF OSTEOPATHY. 




Fig. 62. — Surface marking of the brachial plexus. 



PRINCIPLES OF OSTEOPATHY. 189 

Figure 62 illustrates the superficial area in which the 
reflexes from the skin and muscles of the arm are manifested. 
Subluxations, or muscular contractions, in this area may af- 
fect one or more branches of this plexus. 

Affections of the Brachial Nerves. — Neuralgia, paraly- 
sis or spasm may affect the area innervated by this group. 
Cervico-brachial neuralgia is quite common. A lesion will 
usually be found affecting the painful nerve at its point of 
exit from the spinal column. Paralysis rarely affects this 
plexus independently of the nerves leaving the cord at a lower 
level. Spasm is represented by such a condition as writer's 
cramp. 

Lesions causing cramp or neuralgia may be located at 
the point of exit of the nerve from the spinal column, but the 
clot or other pressure causing paralysis is usually located in 
the brain. Paralysis of the brachial plexus is a part of a hem- 
iplegia ; it does not occur independently of the more general 
condition. Paralysis of certain groups of muscles of the arm, 
forearm or hand can usually be traced to the direct injury of 
individual nerve trunks in the arm. 

Hemiparesis Below Fifth Cervical Vertebra. — Figures 
63, 64 and 65 illustrate the results of pressure upon the spinal 
cord at a point between the fourth and fifth cervical vertebrae. 
The child was not very strong at the time of the injury. A 
slight fall, while playing, subluxated the fifth cervical. No 
notice was taken of this slight fall. The next day, while bath- 
ing the child, the mother noted a peculiarity in the position 
of the shoulder. The arm could not be raised above the head. 
The author examined this case the day the mother discovered 
the change in the shoulder. At first glance from the side, it 
appeared to be a sub-spinous dislocation of the humerus, but 
palpation disproved this. Careful examination showed a hem- 
iparesis of the whole left side below the fourth cervical nerve. 
None of the normal movements were lost, but it required the 
utmost effort of the patient to make them. Now and then the 
left toe would strike the floor too soon and slightly trip her. 
Palpation of the fifth cervical vertebra showed a lateral 



190 



PRINCIPLES OF OSTEOPATHY. 



subluxation. The slightest pressure at this point caused the 
patient to cry out with pain. 

After our examination (these photographs were taken 
at that time) the child was taken to a surgeon, who prescribed 
a surgical operation to stitch the latissimus dorsi to its proper 




Fig. 63. — Front view of case of unilateral paresis. 



position on the lower angle of the scapula. He did not recog- 
nize the paretic condition of the whole left side. After a 
short time, the child was brought to us for treatment. Our 
sole effort was to reduce the subluxation of the fifth cervical 
vertebra. The tenderness was so great that this was mani- 
festly out of the range of possibilities with a delicate child. 



PRINCIPLES OF OSTEOPATHY. 



191 



After two weeks of relaxing around this articulation a di- 
rect movement was made to reduce the subluxation. The 
alignment was perfected, but no immediate good results were 
noted. A continued increase in nerve power has gradually, 
in large measure, overcome the deformity. 

Subluxation of the Scapula. — The deformity is the ef- 
fect of uneven contraction of muscles. The latissimus dorsi, 




Fig. 64. — Side view of case of unilateral paresis. 

rhomboids and serratus magnus are weakened while the le- 
vator anguli scapuli and cervical fibres of the trapezius are 
contracting with their customary power. The muscles inner- 
vated by nerves from above the lesion are acting normally, 
but their action is not resisted. This results in subluxation of 
the scapula. 

The Nerve of Wrisberg. — A division of the first dor- 
sal nerve forms the first intercostal nerve. The inner and 



192 



PRINCIPLES OF OSTEOPATHY. 



back side of the arm receive cutaneous branches from the first 
dorsal nerve. There is communication between the cutaneous 
nerves to this area and the second intercostal nerve by means 
of the nerve of Wrisberg, hence pain is frequently felt along 




Fig.. 6s. — Rear view of case of unilateral paresis. 



the inner surface of the arm in cases of heart trouble, inter- 
costal neuralgia in the second space, or pleurisy. 

The Interscapular Region. — The division of the spinal 
column between the first and seventh dorsal vertebrae is com- 
monly called the interscapular region. It is an exceedingly 
important one. It is sometimes called the pulmonary region, 
because it is the area from which the lungs derive many nerves, 
Sensory impulses from the lungs are co-ordinated in this area. 



PRINCIPLES OF OSTEOPATHY. 



193 




Fig. 66. — Anterior surface markings of the lungs. 

Figure 66 illustrates the anterior surface outline of the 
lungs, while Fig. 67 shows the outline on the posterior sur- 
face of the thorax. These markings were made on the surface 
according to physical methods of diagnosis. They represent 
the average position of the lungs in a healthy man. 



194 



PRINCIPLES OF OSTEOPATHY. 




Fig. 67. — Posterior surface markings of the lungs. 

Lung Center. — Figure 68 illustrates the lung center 
within which sensory impulses from the lungs are co-ordi- 
nated. A large proportion of cases of bronchitis, pulmonitis 
or pleuritis of either the simple or bacterial types, are accom- 



PRINCIPLES OF OSTEOPATHY. 195 

panied by great sensitiveness in this area. This sensitiveness 
is in the contracted muscles or, when the shape of the thorax 
is- greatly changed, at the angles of the ribs. Subluxations 
of ribs or vertebrae in this area are sometimes found in con- 
nection with the inflammations above named. Whether they 
are the cause or the effect of the inflammation can only be told 
by the history. Because the two conditions, that is, inflam- 
mation in the thoracic viscera and osseous subluxation, exist 
at the same time is no reason for saying that the subluxation 
is necessarily the cause of the inflammation. That is a mere 
dogmatic assertion which lacks scientific proof. The condi- 
tion might be just the opposite. We do not desire to confuse 
our readers in the least, but it should be remembered that 
before making a dogmatic statement such as "disease is the 
result of anatomical abnormalities followed by physiological 
discord," we should be certain that our statement is not based 
on a series of selected coincidences. The old saw : "It's a 
poor rule that does not work both ways," is decidedly applicable 
to nerve reflexes. 

Cilio-spinal Center. — Tenderness in this area is not 
necessarily indicative of physiological disturbance in any tho- 
racic viscus. Fig. 69 indicates two centers. The one be- 
tween the second and third dorsal is called the cilio-spinal 
center. Detail concerning this center will be found in the 
chapter on The Sympathetic Nervous System. 

The fact that the vaso-constrictor fibres to the cervical 
sympathetic ganglia leave the spinal cord below the second 
dorsal vertebra show that some reflexes from the head, face 
and neck may be co-ordinated in the interscapular region. 

Heart Center. — The point between the fourth and fifth 
dorsal spines is noted as a heart center. We have not found 
any text-book authority for this statement. Clinical experi- 
ence leads the author to locate a heart center at this point. 
What the absolute influence of this center is we do not know. 
From observation of cases of angina pectoris it appears to be 
a sensory and vaso-motor center for the heart. Stimulation 
of this center by a quick percussion stroke of the fingers will 
bring on an immediate attack of pain in the heart, blueness 



196 



PRINCIPLES OF OSTEOPATHY. 





68. — The lung- center. 



of lips and finger tips. Heavy digital pressure at this point re- 
lieves the pain. Steady extension of the whole spinal column 
does not stimulate such cases, but as the pull is reduced and 
the vertebrae are drawn closer together, this point is fre- 



PRINCIPLES OF OSTEOPATHY. 



97 








Fig. 69. — Cilio-spinal and heart centers. 



quently stimulated. In order to avoid an attack after exten- 
sion, it is necessary to lessen the force of the pull very gradually 
and evenly. 



198 



PRINCIPLES OF OSTEOPATHY. 




Fig. 



-Surface outline of the heart. 



Fig. 70 illustrates the surface markings of the heart. 
This organ has three centers. (1) The pneumogastric nerve 
exerts an inhibitory influence. This nerve can be stimulated 
in the neck. See Fig. 166. (2) The accelerator center in- 



PRINCIPLES OF OSTEOPATHY. 



199 




Fig. 71. — Surface outline of the stomach. 



eludes second, third and fourth dorsal. See Chapter VI on 
the Sympathetic Nervous System. (3) Vaso-motor and sen- 
sory center is found between fourth and fifth dorsal. 



PRINCIPLES OF OSTEOPATHY. 




Fig. J2. — The stomach center. 



Stomach Center. — The surface outline of the stomach 
is given in Fig. 71 while its reflex surface center on the back 
is indicated in Fig. J2. This center lies wholly within the 
pulmonary area, therefore it will be readily noted that there 



PRINCIPLES OF OSTEOPATHY. 




Fig. 72. — The splanchnic area. 



is opportunity for much careful reasoning in order to deter- 
mine whether a lesion between the first and seventh dorsal 
vertebrae is connected with disturbance of the lungs, pleura, 
heart, eves or stomach. Clinically, we distinguish somewhat 



PRINCIPLES OF OSTEOPATHY. 




Fig. 



-Posterior view of a case of leukemia. 



as follows : A lesion covering a large part of this area is 
probably pulmonary. A lesion in the lower half and extending 
below the seventh spine is probably gastric in character. 
When the lesion is at the third or fourth and decidedly lim- 
ited i. e., the tenderness is sharply circumscribed in this area, 
it is impossible to tell, except by further examination of the 
heart, bronchi and eyes, to which it belongs. The experienced 
diagnostician can frequently estimate the probable relation of 
a lesion by his power of reading the signs of disease as evi- 
denced by expression, posture and general indications. 



PRINCIPLES OF OS TEOPA TH Y. 



203 




Fig' 75- — Posterior surface outline of the liver and spleen with their 
centers indicated. 



The splanchnic area is a large and important one. It is 
indicated in Fig. 73. We have noted in this photograph the 
upper connections of the splanchnic nerves in the pulmonary 
area. This explains the high position occupied by some re- 



204 



PRINCIPLES OF OSTEOPATHY. 






J 



Fig. 76. — Side view of case of leukemia. 



flexes from the first part of the gastro-intestinal tract. Won- 
derful influences can be secured in this area, over circulation 
in the abdominal viscera. The physiological actions gov- 
erned from this area are described on page 125. (See Great 
Splanchnics under the Sympathetic Nervous Svstem, Chapter 
VI.) 

Leukemia. — To illustrate the osteopathic view of the 
effect of osseous disorder on the functional activity of 
viscera, we present a series of three photographs, Figs. 74, 



PRINCIPLES OF OSTEOPATHY. 



205 




Fig. yy. — Anterior view of case of leukemia. 



j6 and JJ, of a case of leukemia showing the condition of the 
spine in the splenic area. The marked limited kyphosis in 
connection with the enlargement of the spleen is a striking 
example of the relation existing between a viscus and its 
center. This case has been in our clinic only a short time, 
two weeks, therefore we cannot tell what the effect of the 
treatment will be. It is an extreme case. The blood exam- 
ination shows thirty per cent of hemoglobin. The number of 



2C6 



PRINCIPLES OF OSTEOPATHY 




Fig. 78. — Anterior surface outline of the liver and large intestines. 



white blood corpuscles is 448,000 to the cubic centimeter, 
that is, about forty-four times the usual number. 

The treatment is being limited to the spinal area involved. 
Thus far the patient notes cessation of all pain. 



PRINCIPLES OF OSTEOPATHY. 



207 




Fig. 79. — Center for large intestine. The arrow marks point of close connection 
of cerebro-spinal nerves with the hypogastric plexus. 



Liver and Spleen Center. — The liver and spleen receive 
their sensory and vaso-motor innervation from the eighth, 
ninth and tenth dorsal nerves. The surface markings and 



208 



PRINCIPLES OF OSTEOPATHY. 




Fig. 80. — 'Center for chills. 



center are indicated by Fig. 75. The liver frequently reflexes 
its disturbed sensory influences to the right shoulder. We 
have noted cases of gastric disorder or enlarged spleen which 
reflexed sensory impressions to the left shoulder. 

Large Intestine. — Fig. 78 pictures the surface mark- 
ings of the liver and large intestine. These average normal 
outlines should be thoroughly remembered and used when 



PRINCIPLES OP OS PROP A PH Y. 



209 




Fig. 81. — Center for the gall bladder. 



making a physical examination. The spinal center of the 
large intestine is indicated by Fig. 79. 

Small Intestine. — The first portion of the small intes- 
tine, duodenum, is innervated from about the same area as 



2TO 



PRINCIPLES OF OSTEOPATHY. 





Fig. 82. — Center for the ovaries. Reflexes from the ovaries may follow the ovarian 
plexus to the aortic and reach the cerebro-spinal system at this point. This 
is true for the testes also. 



the liver. Fig. 80. It must be borne in mind that the 
splanchnic area is a large one and comprehends these smaller 
centers. Many of these points indicated as centers are the 



PRINCIPLES OF OSTEOPATHY. 




Fig. 83. — Posterior surface outline of the kidneys. 



areas which clinical experience has noted in connection with 
visceral disturbance. The repeated experience of many cases 
gives them value for diagnostic and therapeutic purposes. 



PRINCIPLES OF OSTEOPATHY. 




Fig. 84. — End of the spinal ccrd. Physiological center for parturition, defection 

and micturition. 

Center for Chills. — Within the area indicated by Fig. 
80, there is a center usually described as the eighth dorsal, 
which has received the name of "the center for chills." Our 
first observation of the action of this center was in connection 



PRINCIPLES OF OSTEOPATHY. 213 

with a case of malarial fever. Heavy inhibition of this area 
lessened the severity of the chill. By following this method 
from day to day, at the time of the onset of the chill, this case 
was cured. Another case treated at the same time did not 
respond to this line of treatment, i. e., the cure could not be 
attributed to this one mode of treatment. Even in this case, 
the inhibition gave relief. We have observed the effects of in- 
hibition of this center in many cases of chill due to nervous- 
ness, onset of La Grippe or othe» infectious diseases, and 
to abscess formation. In all cases the treatment was dis- 
tinctly helpful to the patient. 

The Language of Pain. — Homeopathic medical prac- 
tice notes variations in the character of pain, and uses these 
characteristics as indications for the administration of special 
drugs, as though a nerve fibre expressed a language of pain. 
To the osteopathic physician, it is sufficient that a nerve ex- 
press a disturbance at some point of its course. This cry of 
the nerves calls for just one thing, remove the cause. Search 
is made for this cause along its entire course, and the course 
of its connections. 

Osteopathic View of Pathology. — Another particular 
in which the osteopathic pathology differs from other schools 
of medicine is in the way we view varying conditions of a 
viscus. To the medical practictioner, simple gastritis is a 
vastly different condition from gastric ulcer. To the mind of 
the osteopath, these conditions differ in degree not in kind. 
The same organ, the same blood supply, the same nerves are 
involved in both conditions, therefore we treat these struc- 
tures. Our dietetic treatment takes account of the differing 
activity of the stomach, but our manipulative treatment does 
not. 

We apply this same method to all organs. Our manipu- 
lative therapeutics are based on structure more than on func- 
tion. 

Center for Gall Bladder. — The gall bladder lies under 
the anterior extremity of the tenth rib. In cases of gall 
stone the area of the tenth dorsal spine has been found to be 
sensitive. All of the structural and functional changes con- 



214 PRINCIPLES OF OSTEOPATHY. 

nected with gall stones have seemed to center at this area, and 
along the tenth rib. Fig 81 indicates the center for the gall 
bladder at the spine. 

A Case Report. — Qn October 20th, 1900. a patient was 
brought to the free clinic of the Pacific School of Osteopathy 
for our examination. "The ordinary questions as to history, 
symptoms, etc., were not asked until a thorough physical ex- 
amination had been made. The general appearance of the 
patient was of one greatly emaciated by long illness. There 
was considerable sensitiveness at several points along the 
spinal column, but no apparent mal-position of vertebrae. 
Pressure on a level with the head of the tenth rib, right side, 
caused a painful sensation along the entire course of the tenth 
intercostal nerve ; therefore our attention was called to that 
particular area. The tenth rib was found to be twisted and 
depressed, so that the upper edge of the eleventh rib 
pressed into the groove on the lower border of the tenth, 
which ordinarily protects the tenth intercostal nerve. Thus 
there was a constant irritation of that nerve. This irritation 
was reflexed to the spinal cord and thence over the splanchnic 
nerve to the gall bladder, liver, stomach and spleen. The 
history of the case, physical examination and afterward the 
examination of the gall stones left no doubt as to this wo- 
man's trouble. The cause of the gall stones was the irrita- 
tion of the tenth intercostal nerve caused by the slight dis- 
placement of the tenth rib." 

"Owing to the length of time this irritation had existed, 
the whole sympathetic system seemed to be excited. Stimu- 
lation of the pneumogastric nerve caused the patient to become 
unconscious — inhibited the heart — hence the treatment admin- 
istered was to raise the ribs, replace the tenth, inhibit reflexes, 
and direct manipulation over the gall bladder. " 

"The fact that the treatment, as directed, acted imme- 
diately, shows that it was logical and scientific." 

"We have no doubt there are other causes of gall stones, 
but this is something new to be added to the etiology of the 
disease. It does even more than establish a new etiological 
factor, it helps to establish the claim of the osteopath to a dis- 



PRINCIPLES OF OSTEOPATHY. 215 

tinctive pathology, and a system of therapeutics based on 
anatomy and physiology." — Vol. IV, page 174, The Osteo- 
path. 

Intestines. — The small intestines are governed from the 
lower part of the splanchnic area, ninth, tenth, eleventh and 
twelfth dorsal. The large intestine is controlled by nerves 
from the lumbar region. There is a segmental distribution 
of these nerves to the large and small intestines. This seg- 
mental arrangement is exemplified in cases of diarrhoea. If 
the large intestine is the part affected, our manipulation is 
devoted to the lumbar region. Reflexes from the bowels may 
be found at any point between the ninth dorsal and the fourth 
sacral. 

In five consecutives cases of appendicitis, the reflex was 
located at the third and fourth lumbar spines. Fig. 79 indi- 
cates the area concerned in reflexes from the large intestine. 

Uterus. — The position of the arrow in Fig. 79 indi- 
cates the point of apparently close connection between the 
hpyogastric plexus and the cerebro-spinal system. This point 
is frequently the seat of great tenderness which is entirely 
reflex in character. All of the pelvic viscera at times send 
reflexes here. The uterus more than any other pelvic organ 
manifests its disturbed condition by tenderness at this point. 

The uterus is such a changeable organ that it is the chief 
disturber of sympathetic rhythm in a woman's body. A 
change in its position causes a change in its blood supply fol- 
lowed by congestion of its mucosa. This congested condition 
sets up a series of impulses in the sympathetic system which 
may never reach the cerebro-spinal system. They spend their 
force on the various organs governed by the sympathetic nerv- 
ous system, the heart, stomach, bowels, etc. Fig. 87 illus- 
trates the difference in the hearths rhythm in the same patient. 
The first sphygmogram was taken while the patient had con- 
siderable difficulty in moving about on account of the heart's 
very irregular action. The uterus is prolapsed. Patient has 
worn a stem pessary for years. When the patient takes the 
genu-pectoral position and inhales strongly, while pulling up- 
ward on the abdominal muscles there is great relief, but when 



2l6 



PRINCIPLES OF OSTEOPATHY. 




Fig. 85. — Areas of the lumbar and sacral plexuses. 



the heart becomes as irregular as this sphymogram indicates, 
she is afraid to take this position. After twenty-four to 
seventy-two hours' of irregular action, the heart regains its 
rhythm. The position of the uterus becomes changed by the 



PRINCIPLES OF OSTEOPATHY. 217 

moving of the patient in bed. The perineum is badly torn 
and the uterine ligaments are greatly lengthened, hence the 
organ cannot be kept in one position. She has refused opera- 
tion. 

Many different points are named as centers for the uterus, 
but they all rest on the fact that after the organ has initiated 
a large number of impulses in the sympathetic system, they 
may be passed to the cerebro-spinal system at any point of 
union of the two systems. 

Ovary and Testes. — These organs receive their sym- 
pathetic innervation from the plexus which lies on their 
arteries. The ovarian plexus is given off from the aortic 
plexus which receives fibres from as high as the eleventh and 
twelfth dorsal ganglia. Therefore a lesion in the area of the 
eleventh and twelfth spinal nerves is frequently in connection 
with the ovaries or testes. Fig. 82 indicates the height of the 
influence of the aortic plexus through its direct connection 
with the cerebro-spinal system. 

Kidneys. — Fig. 83 indicates the surface marking of 
the kidneys and the junction of the last dorsal and first lumbar 
vertebrae. Lesions of either the eleventh or twelfth dorsal 
may affect the kidneys. 

The reflexes of this organ may reach the cerebro-spinal 
system over the renal splanchnic. The articulation of the last 
dorsal and first lumbar allows considerable movement. It is 
probably the weakest part of the back. The area of the twelfth 
dorsal nerve is usually sensitive when the kidneys are affected. 
This sensitiveness may extend a short way upward, as far 
as the tenth dorsal. 

In patients whose abdomen is moderately thin, it is pos- 
sible to affect the renal sympathetic plexus by deep manipu- 
lation above the umbilicus. The kidneys lie above the level 
of the umbilicus. Have the patient lie in the dorsal position 
with flexed thighs so as to relax the abdominal muscles. The 
balls of the fingers of both hands should be pressed deeply into 
the abdomen about two inches above the umbilicus, then 
move the fingers laterally toward the kidneys. Pressure is 
thus brought to bear upon the renal artery. The mechanical 



218 PRINCIPLES OF OSTEOPATHY. 

stimulation of the renal plexus usually results in vasoconstric- 
tion of renal arteries. 

Second Lumbar. — The lumbar enlargement of the 
spinal cord is the physiological center for several functions 
performed in the pelvis. Defecation, micturition, and partu- 
rition, are all reflexly controlled at this point, second lumbar. 
The spinal cord ends at the lower border of the first lumbar 
vertebra. The second lumbar vertebra is indicated in osteo- 
pathic literature as a center for the three functions named 
above. We understand by this that an injury at this point 
may involve the functional activity of the rectum, bladder, or 
uterus. Disturbances in these viscera are not necessarily man- 
ifested to the osteopath by tenderness around the second lum- 
bar vertebra. Any point along the spinal column below the 
second lumbar may be sensitive as a result of disturbance in 
the pelvic viscera. Fig. 84. 

During parturition there is conscious aching along the 
whole lumbar area, thus demonstrating that the sensory nerves 
of the uterus can reflex their irritation to all the lumbar 
nerves. Injury of the spinal column at the junction of the 
dorsal and lumbar portions may affect motion, sensation and 
nutrition of all the structures innervated by the cauda equina. 
An injury below the second lumbar vertebra will not have as 
far-reaching effect as an injury of the same character above 
that point. 

Paraplegia. — When the back is broken at the dorso- 
lumbar articulation, paraplegia results. It is not necessary to 
actually break the back in order to cause paraplegia. A se- 
vere strain, caused by a fall may induce such an exudate around 
this articulation that pressure is exerted on the lumbar en- 
largement of the cord. Many of the so-called broken backs, 
which are spoken of as causative of paralegia, are not broken 
at all, but the ligaments are badly sprained. The same con- 
dition exists here as in other sprained joints. There may be 
marked kyphosis, but this does not necessarily indicate dis- 
location. The paraplegic condition may be perpetuated by 
the pressure of connective tissue formed in the repair of the 
injury. This is especially liable to follow if some form of 



PRINCIPLES OF OSTEOPATHY. 



219 




Fig. 86. — Center for the bladder. 



manipulative treatment is not persisted in for from one to 
three years. The author has fortunately been able to observe 
the slow regeneration of nerve tissue following complete para- 
plegia as a result of injury of the dorso-lumbar articulation. 



220 PRINCIPLES OF OSTEOPATHY. 

This case has been observed by us during nearly four years. 
During all of this time, she has received osteopathic treatment. 
This method of treatment was not begun until ten months after 
the accident, therefore, synovial adhesions had formed to such 
an extent in the joints of the limbs that much painful manipu- 
lation of these joints has been necessary. 

Following the accident, there was motor and sensory 
paralysis of the extremities, bladder and rectum. Control of 
the bladder and rectum returned after two months' of osteo- 
pathic treatment. Sensation and motion have returned to the 
extremities. There is deformity as a result of the adhesions 
formed during the ten months previous to the first osteopathic 
manipulation. The patient had been massaged during the ten 
months mentioned. 

Lumbar and Sacral Plexuses. — From the nerves of the 
cauda equina are formed two large plexuses, the lumbar and 
sacral, indicated in Fig. 85. The branches of these plexuses 
innervate the muscles of the lower extremities. The spinal 
area from which these plexuses receive their fibres should be 
carefully examined whenever any difficulty of movement or 
sensation in the lower extremities is presented. 

The student should learn the sensory and motor distri- 
bution of each branch of these plexuses, so that peripheral 
disturbance can be immediately associated with the point of 
emergence, from the spinal column, of the affected nerve or 
nerves. 

The Bladder. — Fig. 86 indicates the superficial area in 
which reflexes from the bladder are most frequently found. 
The sensory fibres to the bladder are found in the first, second, 
third and fourth sacral nerves. The first to third give the 
strongest evidence of sensory disturbance. When the mucous 
lining of the bladder is congested, these sensory nerves are 
stimulated. Motor fibres to the bladder are found in the sec- 
ond and third sacral nerves. The stimulation of the sensory 
nerves results in reflex stimulation of the motor nerves, which 
cause contraction of the muscular tissue of the bladder. In- 
flammation of the bladder is accompanied by almost continuous 
desire to micturate. 



PRINCIPLES OF OSTEOPATHY. 



221 



The sacral spinal nerves take a more direct and unin- 
terrupted course to the pelvic viscera than do nerves from 
other portions of the spinal column to their respective areas 
of distribution. 

Inhibitory pressure over the sacral foramina has a very 
marked effect on the sensory nerves of the bladder. This 
pressure does not directly affect the anterior divisions of the 
sacral nerves, nevertheless the effect is the same as though the 
anterior divisions were subjected to the inhibitory pressure. 



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Fig. 87. — Sphygmograms illustrating the effect of uterine reflexes on the heart. 



This is evidence of the close harmony between the two di- 
visions of a spinal nerve. The inhibitory pressure not only 
lessens conscious pain in the bladder, but also changes the 
vaso-motor conditions. In this respect it much resembles the 
action of heat applied to the surface. 

Sphincter Vaginae. — The sphincters of the vagina and 
rectum are controlled from the area of the third and fourth 
sacral nerves. When the vulva, vagina or rectum are highly 
sensitive, we usually find a hyperaesthetic area at the third 
and fourth sacral spines. When this area is sensitive, the 
point where the pudic nerve crosses the ischiatic spine is also 
decidedly sensitive to pressure. Fig. 88 indicates the super- 
ficial relation of the pudic nerve. This nerve is sensory and 
motor to the skin and muscles of the perineum. This point 
will be found sensitive when the prostate is enlarged ; in fact, 
almost any disorder of the male sexual organism is accompa- 
nied bv this sensitive condition. 



PRINCIPLES OF OSTEOPATHY. 




Fig. 88. — Surface marking of the pudic nerve. 



Inhibitory movements over the back of the sacrum and 
ischiatic spine will result in relaxation of the perineal muscles. 
It affects spasmodic stricture of the urethra in a wonderful 



PRINCIPLES OF OSTEOPATHY. 223 

manner. The local anaesthetic effect of inhibition is not so 
easily demonstrated in any other portion of the body as in this 
sacral area. 

When the uterus is turned either backward or forward, 
or prolapsed there are impulses aroused in sensory nerve fibres 
in the rectum or bladder. These impulses are reflexed to the 
sacral area, while those aroused in the uterus pass to higher 
points in the spinal column. Inhibition of this sacral area 
will have a temporary effect. The only treatment worth while 
is the correcting of the position of the uterus. 

Conclusions. — There are many more so-called "centers" 
mentioned by osteopathic writers. We have not attempted to 
even recapitulate those other centers which seem to us to be 
quite too fanciful for practical use. The centers mentioned 
in this chapter are those which can be demonstrated in daily 
practice, and hence are used continually, both as guides for 
diagnosis and as indications for the application of manipula- 
tive therapeutics. No sympathetic spinal centers for "sensa- 
tion," "motion" or "nutrition" can be demonstrated. These 
are characteristics of nerve fibres in general, and it is entirely 
misleading to limit these characteristics to any one portion of 
the spinal column. Every osteopathic center should be capable 
of demonstration anatomically, physiologically and clinically. 
Only those which can pass this test satisfactorily are worthy of 
our consideration. 



CHAPTER X. 



THE GERM THEORY OF DISEASE. 

The germ theory of the causation of disease has been so 
positively and persistently advocated, during the past decade, 
that any theory which is promulgated contrary to the popular 
view must, necessarily, have a foundation which is capable of 
withstanding the assaults of specific bacteriologists. 

A large proportion of the data used to support the germ 
theorv of disease mav be utilized to show that the final thera- 



224 PRINCIPLES OF OSTEOPATHY. 

peutic methods necessary to combat bacterial diseases are 
essentially osteopathic, i. e., natural. 

Even those who have devoted their lives to the investi- 
gation of the life and activity of bacteria do not agree in their 
conclusions after observing the same phenomena. This is an 
evidence that bacteriology has not passed beyond the stage of 
historical tabulation. The amount of work done and the de- 
votion of the workers speak well for the scientific spirit of in- 
vestigation which has characterized the progress of this theory. 
The irony of it all is the fact that with the heaping of fact 
upon fact, and experience upon experience, it all proves that 
when we eat wholesome, nutritious food, in proper amount, 
labor sufficiently to promote a good circulation, sleep about 
one-third of the time, wear clothing which does not hamper 
cutaneous respiration, drink clean water and reside in well 
drained localities, we have those conditions which are condu- 
cive to a healthy life. This much we knew before, but we 
didn't know it scientifically. 

Specific Causes — Then, too, bacteriology appeals to 
the human instinct to attribute diseased conditions to some 
specific thing. In times gone by, disease has been ascribed 
to all sorts of mythical spirits, cabalistic signs, God's punish- 
ment, etc. Bacteriology is in direct line of descent from these 
conceptions. 

You will note by referring to Chapter II of this book that 
we have taken the broad view — essentially monistic of the 
cause of disease. The osteopath cannot view disease from 
any other standpoint. We must not substitute subluxations 
or muscular contraction for bacteria as the cause of disease. If 
we make this substitution, we are open to as much criticism 
as the specific bacteriologist. 

Bacteriology as it stands today is the result of the study 
into the causes of spontaneous germination, fermentation and 
decay, and the origin of disease. Bacteria are plants of the 
lowest group. Bacteriology includes now, not only the study 
of these low forms of plant life, but also some low forms of 
animal life. 

Bacteriologists have from time to time, classified these 



13 



PRINCIPLES OF OSTEOPATHY. 225 

bacteria into groups according to form, method of forming 
spores, etc. These groups are much disturbed by the way in 
which the members change when grown in different media. 

Conditions which Affect Life. — The first fact of great 
importance to us is that bacteria, like other forms of plant 
life, are greatly affected for their good or ill by their relations 
with other forms of energy, light, temperature, etc. It is as a 
result of experiment to determine the conditions best suited 
for life and growth of bacteria that we now understand pro- 
cesses of sterilization, disinfection, and the use of antiseptics. 
We have learned to destroy or modify the life of bacteria. 

The next great fact is that the human body is a con- 
stantly changing collection of cells whose molecular constitu- 
tion is also varying from day to day and hour to hour. The 
human body is a reservoir of energy with which bacteria come 
in contact. If the resistance of the body is sufficiently strong, 
the bacteria are either killed or reduced in power. The re- 
sistance of the human body is changed for good or ill ac- 
cording to its relations to other forms of energy, such as food, 
sunlight, etc. 

Resistance. — We find that the intensity of the life of 
bacteria and the human body are modified by their food supply 
and their environment. This being true, we are principally 
concerned with knowing what conditions are most detrimental 
to the life and growth of bacteria and the most exalting to 
the general resistance of the body. This is the scientific basis 
of hygiene. 

The human body possesses certain powers which are cap- 
able of combating bacteria. These protective powers have 
been recognized and analyzed by bacteriologists. 

We wish to call attention to the fact that Dr. A. T. Still 
stated, years ago, the physiological axiom that a perfect cir- 
culation of blood is requisite for health, recognizing, of course, 
that the blood must contain the proper food elements for the 
nourishment of the tissues. 

Immunity. — Bacteriological researches have demon- 
strated this statement to be true. We will note some of the 
means whereby the body protects itself from bacteria. The 



226 PRINCIPLES OF OSTEOPATHY'. 

term immunity is applied to that condition of the body which 
exists when specific resistance to bacteria is exhibited. 
Hankins' definition of immunity is as follows : "Immunity, 
whether natural or acquired, is due to the presence of sub- 
stances which are formed by the metabolism of the animal 
rather than that of the microbe, and which has the power of 
destroying the microbes against which immunity is possible 
or the products on which their pathogenic action depends." 
In other words, immunity exists when tissue resistance is 
strong. Immunity is a quality of the body not of the bacteria. 
Immunity is sometimes inherited, a racial peculiarity, or is ac- 
quired by having the disease. It is claimed for vaccine virus 
that by causing the simple condition of vaccinia, the body 
resistance to smallpox is enhanced. Considerable work has 
been done along this line, but it cannot be said to be suc- 
cessful. It is an illogical and dangerous method of building 
up body resistance. Vaccination has a big task to prove an 
alibi in connection with many constitutional conditions fol- 
lowing hard after it. 

We quote as follows from Nancrede's Principles of Sur- 
gery, page 66 : "Observers have extracted certain substances 
— 'defensive proteids' — from the livers and spleens of ani- 
mals, capable of destroying bacteria. These are never found 
in normal blood ; but when the febrile state has supervened, 
these substances in active state are detectable in the circu- 
lating blood. Blood serum is well known to be germicidal in 
virtue of the nucleinic acid it contains, dissolved out of or 
resulting from the disintegration of the Phagocytic leucocytes." 

The relative immunity of certain races to the attack of 
certain diseases, for example, immunity of the negro to yellow 
fever, may prove that there is such a condition as inherited 
immunity, or it may simply demonstrate that the anapholes 
does not enjoy the taste of the negro's cutaneous excretions, 
and therefore does not prey upon him. 

Some persons resist the attacks of bacteria for a long time, 
but finally yield. This condition has been explained by the 
results of experiments made on animals. An animal which 
is known to be immune to a definite bacterium, if fed on such 



PRINCIPLES OF OSTEOPATHY. 227 

food as will radically change the condition of its blood will 
lose its immunity. Fatigue will also destroy immunity. Dur- 
ing and for some time after fatigue the products of metabolism 
clog the tissues, not only obstructing lymphatic circulation, but 
depressing the activity of the tissues, thereby lessening the 
general circulation and loading the blood with waste material. 
Hence, as a result of these experiments it is determined that 
immunity depends upon a perfect circulation of blood, i. e., 
blood containing proper food for the tissues. Nancrede 
writes : "The tissues then can only maintain their normal re- 
sistance by having an abundant blood supply; but this must 
move at a normal rate, in vessels of a certain calibre — although 
these conditions may vary within somewhat wide limits — oth- 
erwise germs will, for purely physical reasons accumulate in 
overwhelming numbers. Still further, if this blood does not 
move at a proper rate, it will not promptly carry away the 
poisonous products of cell metabolism, which will otherwise 
directly injure the cells. Again this poison laden, because 
sluggishly moving blood may incite the tissue cells to abnormal 
metabolism productive of toxic substances, even in the ab- 
sence of germs, which when absorbed will produce most seri- 
ous constitutional effects." 

Since it is clearly recognized that hyperaemia lessens the 
resisting power of the engorged tissue, we can readily under- 
stand how hyperaemia of the intestinal tract opens the road 
to general infection of the body, or how the resisting power 
of any exposed structure, such as the lung will be lessened. 
Therefore, if we can lessen the calibre of blood vessels through 
the medium of vaso-motor nerves, the rapidity of the blood 
current will be increased and the resisting power of the tissues 
restored. 

The phagocytic action of some luecocytes and fixed endo- 
thelial cells serves as a protection to the body. These phago- 
cytes have the power to encapsulate a bacterium or spore and 
even in death set free nucleinic acid which is antiseptic . 

Besides this power of a certain class of blood corpuscles 
to rid the system of bacteria, the liver, spleen, kidneys ancY 
intestines are active agents in eliminating germs from the 



228 PRIXCIPLES OF OSTEOPATHY. 

body. This indicates to us that we may assist nature in over- 
coming bacteria by removing obstructions to the circulation, 
and by stimulating the eliminating organs of the body. 

It is a well-known fact that one attack of certain germ 
diseases gives comparative immunity to the individual as far 
as future attacks of the same bacteria are concerned. It is 
on this fact that vaccination is based. It is true that an attack 
of typhoid fever gives a degree of immunity to future attacks 






■a; 



S* | 



> ; - i - 



<& v 1 



Fig. 89. — Tubercle bacilli in sputum. Photomicrograph made by J. O. Hunt, D. O. 

of the typhoid bacilli, but it also gives susceptibility to the 
attacks of some other bacilli, i. e., the cells learn to resist 
typhoid bacilli, but not tubercle bacilli, hence if we depend 
upon immunity acquired by having a disease, or by innocu- 
lation, we may be immune only in a special way not strength- 
ened in general tissue resistance. 

Specific Treatment. — Physicians of all schools of prac- 
tice have been imbued with the idea that specific treatment 
is the logical sequence of the discovery of bacteria. On this 
basis intestinal antiseptics were recommended for typhoid 



PRINCIPLES OF OSTEOPATHY. 229 

fever, and diphtheria antitoxin for diphtheria. The antiseptic 
treatment for typhoid fever has proved decidedly unsatisfac- 
tory. Drug medication aims to stimulate cell resistance. 
This method has proved unsatisfactory, although the object 
aimed at is the right one. The simple hydriatic measures em- 
ployed by the early empirical hydropaths were so eminently 
successful that water is now recognized as the best means 
of stimulating cell resistance. Under this method the death 
rate of typhoid fever has been reduced to two or three per 
cent. 

Diphtheria is the best example of the bacteriologist's spe- 
cific methods of treatment. It is a well recognized fact that 
one attack of this disease does not confer immunity. Dr. Fer- 
dinand Hueppe, Professor of Hygiene in the University of 
Prague, a bacteriologist, who has developed from that hot- 
bed of bacteriologists, the Prussian Army Medical Depart- 
ment, writes as follows in his work on the Principles of Bac- 
teriology: "Favorable specific effects, such as an immunity 
against living parasites and an habituation to their poisons, 
are often deceptive, if we fail to consider sufficiently the 
method of introduction or innoculation. A state of protection 
by way of the skin may be present in cases where immunity 
does not exist at all to infection by way of the blood or 
brain ; it may be present for one side of the body or for one 
extremity and be lacking in other organs. If this fact is for- 
gotten then it may appear as if the influence of the body fluids 
were pre-eminent, but in reality the last word rests with the 
body cells. On this basis Schleich has very happily attempted 
to explain why diseases like diphtheria, that start from the 
membrane of the throat, or that start in the lungs, like pneu- 
monia and influenza, or from the intestines, like cholera, con- 
fer upon the organism little or no immunity from another at- 
tack; it is because large tracts of cells remain exempt from 
the effects of the first invasion and therefore acquire no protec- 
tion. It seems as if, perhaps, toxic properties did not exist 
when in reality toxic manifestations are prevented only by 
chance. The alleged non-poisonous diphtheria serum itself, 
when introduced into the derma shows a toxic action which 



230 PRINCIPLES OF OSTEOPATHY. 

manifests itself in pains and in swelling of the joints and in 
the form of peculiar and obstinate skin affections at times like 
those of scarlet fever or measles, as well as in bleeding, kid- 
ney inflammation and paralysis, and it is very doubtful whether 
the list of possible injuries is yet exhausted, for perhaps other 
mischievous effects may come to light with other methods of 
use. Occasionally marked degeneration of heart, kidney and 
liver are witnessed immediately after the injection of the diph- 
theria serum ; and this fact shows clearly that in the use of 
this antitoxin a danger exists of the same character as that 
displayed in Buschke's experience with the tetanus serum. If 
the action of the serum were simply antitoxic, danger of this 
kind ought to be impossible. We have a paradox of an anti- 
toxin producing a toxic effect. According to Emmerich, ani- 
mals that have been treated with diptheria serum afterwards 
succumb more easily to an infection with Staphylococci and 
Streptococci, a fact that points also to the poisonous action 
of the antitoxin upon the tissues. In man an acute outbreak 
of tuberculosis has been more than once observed to follow a 
serum injection." 

Several specific methods of treating so-called germ dis- 
eases have flashed on the horizon of medicine, but thus far 
none have proved generally successful, at least, the cures at- 
tributed to them are not lifted out of the realm of coinci- 
dence. 

As long as the fact exists that many cases of diphtheria 
get well under osteopathic treatment, which is addressed pri- 
marily to increasing tissue resistance by maintaining a perfect 
circulation of blood, we are justified in using the manipulatory 
method, which is free from the dangers attendant on the ad- 
ministration of antitoxin. 

Summary. — We have tried to show in this very gen- 
eral chapter on germ diseases that, (i) both bacteria and the 
human body, being living organisms, the intensity of life is 
modified by their food and their environment; (2) bacteria 
can be reduced in strength or killed by heat or chemicals ; 
(3) when the bacteria are in the body, the use of chemicals 
cannot be specific, because the body cells may be adversely 



PRINCIPLES OF OSTEOPATHY. 231 

affected as well as the bacteria ; (4) serum-therapy is not 
specific because it also is not without danger to the body 
cells; (5) the resistance of the body cells increases under the 
influence of favorable food and environment. Therefore, those 
methods which enhance general tissue resistance are the proper 
methods to use in the treatment of germ diseases. 

The sanitary methods which are gradually being evolved 
for the betterment of our health are applied to those condi- 
tions which nurture and increase bacteria before they enter 
the human body. By decreasing the strength and number 
of bacteria on the one side and increasing the tissue resist- 
ance of our bodies on the other, we combine sanitation and 
hygiene in the most successful manner. 

Mankind must not depend on osteopathy or any other 
system of medicine to guard him from the inroads of disease. 
True, we can ofttimes find a structural defect which has a 
bad effect on some particular function, but it is not sufficient 
to remove this defect and leave the patient to feel that he has 
no active part to perform. The only kind of inoculation we 
advocate is that which inculcates the idea of personal respon- 
sibility for disease. We quote again from Hueppe : "If a 
person contracts a bacterial disease, tuberculosis for example, 
then, according to Koch, only the tubercular bacillus can be 
held responsible. It is just this belief that has made the 
science of bacteriology so popular in the eyes of the unreflect- 
ing multitude and of many easy-going physicians. We need no 
longer, it is supposed, be solicitous about our own mistakes 
and peccadilloes. Come what may, we are morally protected, 
and, secure in the consciousness of our individual merit, we 
now lay all responsibility upon 'the bacteria' as formerly upon 
'catching cold.' A fatal blow is dealt to these self-deceptions 
and illusions by simply pointing to the fact that bacteria pro- 
voke fermentation only when they come in contact with fer- 
mentable substances under proper conditions, and produce ill- 
nesses and disease only when predisposition towards disease 
exists. Such liabilities of predisposition, we may either in- 
herit from others or acquire by faults of our own. When no 
susceptibility to disease exists, we may harbor the bacillus 



232 PRINCIPLES OF OSTEOPATHY. 

with impunity. We should, then, revile the malicious bacteria 
no longer, but take ourselves to task and mend our ways. Not 
that, some measures of reform having been effected, we should 
behave ourselvse irrationally for eleven months in the year, 
then go to a medical Tetzel and have prescribed as indulgence 
a four weeks' sojourn at a watering place. It is better for the 
majority of men to put themselves, through sensible ways of 
living, into such a condition that bacteria can get no lodgment 
in their systems. This, in a few words, is the practical lesson 
of bacteriological discoveries, Koch to the contrary notwith- 
standing. It is the less comfortable doctrine, but it is scien- 
tifically more nearly correct than the other." 

The purpose of this chapter will be amply fulfilled if it 
arouses the reader to pursue investigations, and study along 
the lines here laid down. We have not considered it worth 
while to recount here a long list of cases of bacterial diseases 
successfuly treated by osteopathic methods. 

We may sum up our conclusions as follows : The blood 
contains the ingredients for overcoming bacteria. In order 
to afford the blood the greatest opportunity to exercise its 
antiseptic qualities, it must circulate freely and be fed properly. 

The heart is controlled by nerves from a definite center, 
which is in connection with the surface. Large vascular areas 
are in close central nervous connection with the surface of 
the body, therefore, the anatomical and physiological factors 
are present whereby we may influence circulation by manipu- 
lation or other therapeutic methods affecting the surface of 
the body. 

The eliminating powers of the kidneys and intestines 
can be effected by therapeutic methods applied to the skin and 
mucous membranes. 

Therefore osteopathy treats germ diseases by removing 
obstructions to the circulation of the blood and to the elimi- 
nating power of the emunctories, and by attention to sanita- 
tion, diet and hygiene. 



PRINCIPLES OF OSTEOPATHY. 233 



CHAPTER XL 



ACCOMMODATION AND COMPENSATION. 

Examination of patients frequently reveals the results of 
accidents or disease which do not appear to have any present 
deleterious influence on their health. It is always necessary 
for the physician to estimate the relations which these changes 
have, in the past, borne to the general health, or may at pres- 
ent, be liable to exert under known conditions of climate, diet 
and environment. 

Definition. — In speaking of structural and functional 
changes, we use the words accommodation or compensation. 
Accommodation means "adaptation or adjustment;" histo- 
logically, "the occurrence of changes in the morphology and 
function of cells following changed conditions." Compensa- 
tion means, "to make up for," "to counterbalance," "that 
which makes good the lack or variation of something else." 
The examples of accommodation and compensation are very 
numerous and it is necessary for the physician to be able to 
recognize the cases in which the body has exercised, or may, 
with proper assistance, exercise this power to a great degree. 
It is sometimes said that disease is an effort of the body to 
accommodate itself to new conditions, that is, changes in the 
quantity and quality of stimuli occasioned by variations in 
climate, diet, environment or accident. 

Osteopathy apparently originated from the fact that struc- 
ture affects function. With this as a basis, all examinations 
are made from the structural standpoint and therefore if we 
follow this method too literally we are apt to overlook the 
fact that the cells of our bodies have the power of accommo- 
dating themselves to very pronounced changes in all those 
things which are considered essential to perfect functioning. 
Function in these affected cells may not be perfect, measured 
by their former activity, and yet apparently answer all the de- 
mands made upon them by the conscious or sympathetic life of 



234 PRINCIPLES OF OSTEOPATHY. 

the individual. There may be other cells, somewhat similar in 
character whose increased activity can compensate, that is, 
"make good the lack of" activity in the affected cells. 

The Spinal Column. — The examination of the spine fre- 
quently reveals the irregularities in its structure. Disturbed 
function in some viscus or other group of tissues is sometimes 
attributed to this structural variation even when no direct nerve 
influence over the affected tissues can be directly traced to the 
spinal area. Mere change in structure cannot warrant us in 
considering it primary to a functional disturbance which does 
not exist in a location whose control can be traced to it. The 
effort on our part to always connect structure with function, 
having the relations of cause and effect, sometimes leads to 
very far-fetched reasoning. It is necessary for us to decide, 
in a given case, whether or no the present condition of the 
individual is as good as it can be made. Our decision will 
manifest to the keen observer whether we have recognized 
the extent of possible accommodation and compensation. 

Curvatures of the spine present many phases which must 
be considered before treatment is begun. The curvature of 
an old case of Pott's disease seldom affects sympathetic life 
to the extent that we would expect. The very gradual pro- 
gress of this disease seems to give ample opportunity for the 
structures in close relation to the diseased area to accommo- 
date themselves to the changed conditions. It is hardly con- 
ceivable that anyone would fail to recognize the accommoda- 
tion manifested in these cases, and yet we have heard of those 
who advocated forcible straightening of the spine. The ques- 
tion to be decided is whether it is better to risk life by forcible 
straightening of the spine or endure deformity with fair 
health. Deformity is always a wound in the self-esteem of 
the individual: Many would risk life time and again to be 
rid of it. It is this which gives the experimenting physician 
or surgeon ample opportunty to try his skill or his ignorance. 
It is all one to the patient, a chance to be rid of deformity. 

Compensatory Curvature. — A lateral curvature of the 
spine usually has two parts, the primary and the compensa- 
tory curve. The compensatory curve is the effort to maintain 



PRINCIPLES OF OSTEOPATHY. 235 

the erect position, that is, have the shoulders and hips level. 
The physician must determine which is primary and which is 
compensatory. 

When the hip is dislocated or any condition exists which 
shortens one leg, the spinal column is curved to compensate 
for this reduced length. It would be useless to treat a com- 
pensatory spinal curvature without lengthening the leg by 
reducing a hip dislocation or putting an extension on the 
shoe. When the femur is dislocated, all the thigh and hip 
muscles accommodate themselves to a new position, then the 
spinal column curves to let the pelvis tilt enough to compen- 
sate for the lack of length in the extremity. The longer the 
dislocation has existed the more perfect is the accommoda- 
tion and compensation. To reduce the dislocation we must 
undo the work of accommodation, that is, lengthen the muscles 
and force the head of the femur into the acetabulum. In 
cases of congenital hip dislocation it is questionable whether 
they can be reduced by the slow osteopathic method of re- 
laxing the muscles. Accommodation and compensation are 
very pronounced in these cases. The acetabulum having 
never been used is practically non-functional. We have seen 
Dr. Lorenz demonstrate his radical method for the reduction 
of congenitally dislocated hips, but we are not able to give the 
final result because sufficient time has not elapsed. Judging 
from our previous personal examination of some of the cases 
he operated upon, we are opposed to treating them osteo- 
pathically or otherwise. They were healthy, active children. 

The Extremities. — Accommodation and compensation 
can be noted very quickly in many cases of injury of the ex- 
tremities. A fixed scapulo-humeral articulation is partially 
compensated for by increased mobility of the scapula on 
the thorax. When the anterior tibial group of muscles is 
paralyzed the patient compensates for inability to raise the 
toe by flexing the thigh. When the hip joint is fixed in the 
extended position, the lumbar portion of the spinal column 
becomes very flexible. 

The Thorax. — Drooping of the ribs lessens the antero- 
posterior diameter, but increases the vertical diameter. The 



! 



236 PRINCIPLES OF OSTEOPATHY. 

full round chest of large capacity is usually less flexible and 
active than the small chest. The question in each case is 
whether the thorax is doing the amount of work necessary for 
the body. 

All individual spinal lesions must be judged carefully as 
to their relations to functional disturbance. The fact that 
spines develop unevenly in many cases makes it hard to de- 
fine their exact condition. A lateral subluxation may exist to 
which the body has become accommodated. To reduce this 
subluxation might again subject the individual to disturbed 
function. 

Skin and Kidneys.— A spinal lesion might cause a dis- 
turbance in the functioning of the kidneys, decrease of activity, 
which in turn is compensated for by increased activity of the 
skin, which in time is compensated for by increased activity 
of the bowels. The diarrhoea in this case would be compen- 
satory and yet it is very difficult for the physician to note this 
fact. If therapeutic means were used to stop the diarrhoea 
and the kidneys or skin did not immediately take up the work 
of elimination, the body would call upon the serous mem- 
branes and areolar tissue to take care of the surplus liquid 
in the circulation. As a result there would be edema of the 
extremities, ascites, pleuritic effusion. When all the serous 
cavities, pleura, pericardium, peritoneum and tunica vaginalis, 
and areolar tissues were well filled with liquid, even the 
cranial and spinal cavities would be pre-empted, thus destroy- 
ing the nervous tissue. 

The compensating action which may take place between 
the kidneys, skin, mucous and serous membranes is one which 
is more frequently recognized and made use of by physicians 
than any other example of the same power manifested in the 
body. The fact that the skin and kidneys respond to each 
other's needs, forms the basis for many therapeutic pro- 
cedures. Mucous membranes become active when the skin 
fails. Perspiration reduces activity of the mucous membranes. 
Serous membranes cease their excessive activity when mucous 
membranes eliminate freely. The oedema of areolar tissue 
gives way to activity of mucous membranes. The physician 



PRINCIPLES OF OSTEOPATHY. 237 

must recognize which is the diseased tissue and which is the 
compensating one. The failure of the kidney to excrete might 
not be the fault of its own structure, but result from the vis 
a tergo given the. circulation by a diseased heart. 

The Heart. — Compensation by the heart for some me- 
chanical defect in it, is the most interesting subject studied 
by the physician. As a result of contraction of the orifices 
of the heart or faulty action of its valves, there is an increase 
in the size of one or more of its chambers. This increase is 
at the expense of the thickness of its walls, thus resulting in 
disproportion between the size of the cavity of the ventricle 
or auricle and the amount of muscular tissue required to 
empty them of their contents. When the proportion between 
the cavity and its walls is so far restored that the heart is 
able to overcome the stasis of the blood in that portion of the 
circulatory apparatus behind the lesion, we say that compen- 
sation exists. The ability to recognize the existence of a heart 
lesion is of great value to a physician. 

Power of Encysting. — In this western country, Califor- 
nia, Ave have ample opportunity to witness the ability of in- 
dividuals to do hard, tedious work after a considerable por- 
tion of the lung has been diseased and expectorated. The 
healing which takes place under favorable climatic condi- 
tions, seems to leave the remainder of the lung in perfect func- 
tional condition. We have examined two cases in which the 
whole right lung was destroyed and the heart had been drawn 
into the right half of the thorax. Both of these individuals 
were able to compete with their more perfect fellows for a 
living by doing hard manual labor. One of these patients 
had a discharging abscess in the axillary line between the 
ninth and tenth ribs. This abscess had discharged continu- 
ously for four years. The patient did not complain of a single 
symptom of ill health. He earned his living as a miner. 
This shows how thoroughly the system may become accom- 
modated to very marked changes in the condition of its tissues. 
This abscess was in the man, but apparently not affecting his 
functions. Probably the abscess was walled off from the 
active body tissues by a protective membrane such as that 



238 PRINCIPLES OF OSTEOPATHY. 

which surrounds a tubercle in the lung and separates it from 
the healthy tissue. 

The history of the lodgment of bullets in various portions 
of the body demonstrates that what cannot be thrown off by 
ordinary means may become encysted and thus not interfere 
with the activity of the tissues. 



CHAPTER XII. 



INHIBITION. 

Acceleration — Inhibition. — We have noted in the chap- 
ter on irritable tissue that the attributes of nervous tissue are 
irritability, conductivity and trophicity. We may add to 
these acceleration and inhibition. We do not use the terms 
stimulation and inhibition as denoting opposite conditions, be- 
cause stimulation applies to the initiation of an impulse. This 
impulse may be acceleratory or inhibitory in character. We 
may stimulate a nerve whose chief function is inhibition. An 
impulse whether acceleratory or inhibitory in character is the 
result of stimulation. 

All bodily functions require stimulation, in the sense we 
have used the term, i. e., something must initiate an impulse 
which is designed to excite activity. After this activity is 
started, it must be governed. It is the means of governing 
these activities we are interested in studying. 

It is not our aim to make an exhaustive study of the in- 
nervation of each organ in order to understand the manner of 
governing activity in them. Only the simplest and most use- 
ful points will be noted here. 

Muscular Contraction. — Muscle may be stimulated to 
contraction. This contraction may be increased or decreased, 
thus showing that after the initiatory impulse starts on its way 
to the point of conversion into work done by the muscle it is 
accelerated, increased, or inhibited, restrained by certain in- 



PRINCIPLES OF OSTEOPATHY. 239 

fluences which we cannot easily analyze. The contraction and 
relaxation phenomena of muscle are equally important. Vaso- 
constriction and vasodilation are examples of these phe- 
nomena. 

Secretion. — The activity of secretory tissues is regu- 
lated by some arrangement similar to that controlling muscu- 
lar action. After a cell becomes active It ?-s still under the 
control of a governing center which accelerates or inhibits ac- 
cording to the necessities of the case. 

Acceleration and Inhibition as Attributes of Nerve 
Tissue. — Cells are full of potential energy which needs a 
stimulus to start its conversion into kinetic energy. We may 
ask ourselves the question, Why isn't all of the potential energy 
converted into kinetic at one time or in response to a single 
stimulus? If the explosive material in a magazine is ignited 
it all explodes, there is complete conversion of potential into 
kinetic energy. There is no restraining or accelerating in this 
case. The element, nitrogen, whose liberation in this case 
causes such dire results, is the same element in the cells whose 
liberation is noted as "work" done by muscle or gland. Why 
isn't all of the nitrogen in the cells liberated by a single stimu- 
lus as in the magazine? We can think of no explanation ex- 
cept that impulses passing over nerves are qualified by other 
impulses passing over other nerves, the two stimuli of opposite 
character thus modifying each other, or in some cases, adding 
their forces when of like character. 

Inhibition as an attribute of the nervous system does not 
seem to be exercised in short reflex arcs, neither does it ap- 
pear to be exercised by centers in the spinal cord. It may be 
that a certain amount of inhibitory influence is exerted 
in these subsidiary centers, but thus far investigations 
demonstrate this attribute to be possessed by the brain 
cells. Experiments on pithed frogs by members of my classes 
showed that stimuli, electrical or mechanical, applied to the 
spine called forth the fullest possible contraction of the ex- 
tensor muscles. Every stimulation excited a veritable explo- 
sion of energy. The spinal cord of the frog functionates in 
a more independent manner than does that in man, hence if 



240 PRINCIPLES OF OSTEOPATHY. 

inhibition were an attribute of these spinal centers, we would 
expect it to be manifested in the frog. The strength of the 
stimulus seemed to have no qualifying effect on the strength 
of the contraction, i. e., weak or strong stimuli brought forth 
a strong response. Two matches will not cause a given amount 
of powder to explode harder than will one. 

Is the Work Done, Proportionate to the Strength of 
Stimuli? — In therapeutics, we are compelled to consider 
the question: Is the amount of work done by muscle or 
gland proportionate to the strength or number of stimuli ? We 
say, Yes ! This answer is made as a result of observation and 
experiment, and our further consideration of the subject of 
inhibition will be from this standpoint. 

Inhibition a Normal Attribute of the Central Nervous 
System. — Inhibition is a normal restraining influence pos- 
sessed by the central nervous system. When the osteopathic 
physician speaks of inhibition, he means a therapeutic pro- 
cedure which exercises a restraining influence over some func- 
tion. This restraining influence being independent of that 
inhibition which is an attribute of the central nervous system. 

Anything which decreases the number or strength of sen- 
sory impulses reaching a reflex center is inhibitory in charac- 
ter. The medical profession has made use of a large number 
of agents for this purpose, opium, for example. 

Physiological Activity Is the Result of Stimulation. — 
All the functions of our body are initiated by stimuli. It 
must not be inferred from this statement that the author is 
satisfied that life consists of nothing but reflexes. So far as 
we can note the phenomena of muscle and gland, we are com- 
pelled to recognize the fact that most of them are reflexes. 
Work done by muscle and gland is initiated principally by 
sensory stimuli. Excessive sensory stimuli excite increased 
work in muscle and gland, sometimes to the point of exhaus- 
tion. To decrease the amount of work, we must decrease the 
number of stimuli. The stimuli originate at the periphery of 
sensory nerves. Sensory nerves are most numerous in the 
skin, mucous membrane and muscle. Inhibitory influences 
must be applied to one or more of these structures. Skin is 



PRINCIPLES OP OSTEOPATHY. 241 

the surface tissue, richly supplied by sensory nerves, and un- 
der it are muscles also well supplied by sensory nerves. 

Hilton's Law. — Hilton, by showing that the skin, mus- 
cles and synovial membrane of a joint, or the skin, muscles of 
the abdomen and contents covered by peritoneum are inner- 
vated from the same segment of the cord, laid a foundation 
for the rational use of inhibition in osteopathic practice. 

Inhibition — Therapeutic. — Inhibition as a therapeutic 
procedure consists in a steady, digital pressure made over 
some nerve trunk, or over an area which is closely connected 
with a spinal segment from which nerves pass to an internal 
viscus which we desire to affect. 

In order to explain the necessity for this movement and 
its beneficial effects, we must note the prenomena of vaso 
motion. 

How Vaso-motor Centers Act. — Vaso-motor centers act 
according to the sum of the stimuli reaching them from skin, 
muscle, glands, etc. If the sensory nerves of one lateral half 
of the body are stimulated, as by pricking with needles, the 
temperature of that half of the body will be higher than the 
other, thus demonstrating that excessive stimulation of sen- 
sory nerves ends in vaso-dilation, i. e., loss of tone of the mus- 
cular coat of the blood vessels. Since excessive, i. <?., over- 
stimulation of sensory nerves in this experiment causes inhi- 
bition of vascular tone and hyperaemia results, we argue that 
any procedure which lessens the excessive amount of stimula- 
tion passing to a vaso-motor center will favor the return of 
vascular tone. Therefore since it is easily demonstrated that 
digital pressure lessens pain and sensitiveness in the area 
pressed upon, we know that the registering power of these 
peripheral nerves is decreased, and there results a better vas- 
cular tone in that area. 

Over-stimulation Equals Inhibition. — If over-stimula- 
tion results in inhibition of vascular tone, as the above experi- 
ment seems to demonstrate, then it appears rational to de- 
crease the stimulation to a point where vascular tone is not 
disturbed. Digital pressure does decrease the irritability, 
therefore, we may express ourselves as follows : Inhibition of 



242 PRINCIPLES OF OSTEOPATHY. 

sensory nerves, in skin and muscle, which are over-stimulated 
will favor the return of vascular tone in all areas which are 
supplied with nerves from the same segment of the cord. 

Over-stimulation of sensory nerves causes vascular dila- 
tation. Inhibition lessens the irritability of sensory nerves and 
hence decreases the number of stimuli reaching the vaso-motor 
centers, thus allowing a return of vascular tone. 

The Guide for the Use of Inhibition. — Knowing the 
complete distribution of any nerve trunk, we may judge the 
condition of the internal structures, supplied by one of its 
branches, by the physiological activity of surface tissues, sup- 
plied by others of its branches. In this way we are guided as 
to our use of inhibition. 

Pathological Changes Which Accompany Over-stimu- 
lation. — If an individual eats a hearty meal and before it is 
digested eats another and continues the process, the stimulation 
of the sensory nerves in the mucosa of his digestive viscera 
results in a physiological hyperaemia which, under the cease- 
less stimulation of the presence of food, finally becomes 
chronic. The liver becomes hyperaemic, and its sensory nerves 
are stimulated by the increased amount of blood present in the 
capillaries. These sensory nerves do not register their im- 
pressions on the sensorium of the brain, but do excite that 
area of the spinal cord with which they are connected by 
means of the rami-communicantes. This area of the spinal 
cord lies between the sixth and tenth dorsal spines. From 
this area nerves pass to the deep muscles of the back. These 
muscles are excited to undue contraction, and their sensory 
nerves are thereby made sensitive. The capillary circulation 
in these muscles is poor, thereby increasing the muscular sen- 
sitiveness. This muscular sensitiveness, or rather increased 
stimulation of the sensory endings in the muscles sends a 
new set of impulses to the same area of the spinal cord, sixth 
to the tenth dorsal, and the cord reflexes them back to the sym- 
pathetic system. Thus a figure 8 is formed with the union of 
the circles representing the spinal cord. With impulses enter- 
ing the cord from both loops, sympathetic and cerebro-spinal, 
the cord itself becomes hyperaemic. The constant interchange 



PRINCIPLES OF OSTEOPATHY. 243 

of reflexes which were originated by excessive demands on the 
physiological activity of the tissues involved, either ends in a 
spasmodic effort of nature to rid itself of the intolerable con- 
dition by means of a "bilious spell," or the hyperaemia causes 
excessive secretion of mucus, hypertrophy of connective tissue 
and atrophy of parenchymatous tissue. The bilious spell is 
nature's safety valve. 

Rational Treatment. — After such a condition, as we 
have described, is well established, dieting merely lessens the 
reflexes in the sympathetic portion of our figure 8. The re- 
flexes in the cerebro-spinal portion are still active, because the 
deep muscles of the back have become chronically contracted 
and continue to over-stimulate the sensory nerves. These ce- 
rebro-spinal reflexes still help to maintain the hyperaemia of 
the spinal cord which continues to disturb the rhythm of the 
sympathetic. Manifestly, the treatment must consider both 
portions of the figure of 8. ! Dietetics will lessen to some extent 
the hyperactivity of the sympathetic loop. Digital pressure, 
inhibition, will relax the spinal muscles and lessen the hyper- 
activity of the cerebro-spinal loop. The two lines of treat- 
ment will decrease the number of stimuli entering the segment 
of the spinal cord, sixth to the tenth dorsal, hence there will 
cease to go out from that segment a series of impulses which 
have tended ^^pervsrr^the-sec^etion in the digestive viscera. 

The contraction of the spinal muscles may have sub- 
luxated a vertebra which then becomes a source of irritation. 
In such a case, a movement to replace the vertebra in its true 
relation acts in the nature of inhibition, i. e., it ceases to cause 
excessive stimuli to enter the spinal cord. 

Digital pressure on contracted dorsal muscles causes sen- 
sitiveness, i. e., consciousness of the fact that the nerves in 
that region are abnormally irritable. The sensitive area along 
the spine will be in direct central connection with an internal 
viscus which is equally if not more sensitive. 

Hyperaesthesia of Sensory Areas — Diagnosis. — The 
hyperaesthesia of sensory areas along the spine is of practical 
value for diagnostic and therapeutic purposes when we know 
their nerve connections. By inhibiting a hypersensitive spinal 



244 PRINCIPLES OF OSTEOPATHY. 

area, we set up a change in an area of low sensibility, i. e., a 
visceral area. The inhibitory pressure does not merely deceive 
consciousness by lessening the power of its informing nerves, 
which alone have power to stir up those reflexes which will 
tend to assist the diseased part to return to normal. 

Results of Inhibition. — We know that inhibition les- 
sens pain in the area of conscious sensation. The result of 
daily practice teaches us this. 

Reflexes which are sufficient to cause pain are abnormal 
and tend to set up other reflex actions until the possibility of 
a return to normal action is greatly impaired. Example : In- 
flammation of the pleura causes muscular contraction in the 
muscles of respiration ; the chest is held immobile and adhesion 
of the pleural surfaces results. Inhibition allows movement of 
the surfaces, thus overcoming the tendency to adhere. 

Pain often sets up activities which are detrimental to ten- 
dencies of reparative reflexes. 

Inhibition of painful areas does more than lessen pain ; it 
aborts those impulses which are the result of pain, and sends a 
counter impulse into the center, which in a measure, negatives 
the original impulse. If this were not so, we could not stop 
vomiting, intestinal peristalsis or uterine colic. We know that 
inhibition of a sensory area of the spine not only stops pain 
in that area, but also pain, if there is any, in the viscus which 
is in central connection with it. Therefore, if we affect the 
tonus of both skeletal and involuntary muscles, sensation in 
the cerebro-spinal and sympathetic systems, we certainly affect 
the calibre of blood vessels and the activity of secretory and 
excretory glands. 

It is not too much to say that inhibition does not deceive 
consciousness by lessening the power of registering nerves, but 
does stop a storm of reflexes which have no reparative tend- 
ency, and that it does affect the area of low sensibility, as is 
evidenced by a change in the condition of its musculature, 
blood supply and secretory activity. 

There are many osteopaths who contend that the key-note 
of all manipulative work, according to osteopathic principles, 
is the discovery and removal of a "lesion," osseous in character. 



PRINCIPLES OF OSTEOPATHY. 245 

With this idea carried to extreme, the author has no sympathy. 
In connection with this idea the student is referred to the 
chapter on Subluxation, page 144. 

The Phrase "Remove Lesions." — The phrase "Re- 
move Lesions'' is a good one, and yet it is inexact in many cases. 
It is an elastic phrase and capable of many and varied inter- 
pretations. Each year of active practice adds to the osteo- 
pathic idea of what lesions are. Our literature contains many 
references to lesions which are not mentioned in Dr. Still's 
writings, and yet Dr. Still's basic work has made the later 
conception possible. Osseous lesions have always been para- 
mount in our work and thought, but muscular lesions now 
hold an equal place and bid fair to lead when we see more 
clearly into the subject. 

The Human Body is a Vital Mechanism. — We say that 
"when the anatomical is absolutely correct, the physiological 
potentiates." This conception is based on the statement that 
the human body is a machine. The human body is vastly more 
than a machine. It is a vital mechanism, and the fact that 
it is vital renders it susceptible to other influences besides 
mechanical, such as falls, twists, strains, etc. We may truth- 
fully say that when the physiological is over active, the ana- 
tomical alignment is disarranged. The principles of osteo- 
pathy as they were first promulgated declared that a structural 
defect is at the bottom of every physiological defect. Struc- 
ture always affects function. A sufficient number of cases 
were found to give a foundation of fact to this statement. 
Hasty reasoning tried to make this an all-embracing prin- 
ciple applicable to every case of disease. Other schools of 
medicine have made similar mistakes. The allopathic school 
promulgated the "law of contraries." The homeopathic school 
holds aloft the "law of similars." Neither of these are laws. 
A law is absolute, no exceptions are tolerated. If there are 
any exceptions to a so-called law, it ceases to be a law. 

Structure vs. Function. — Structure affects function and 
function affects structure. Based on the first part of this 
sentence, we have the osteopathic subluxation theory. The 
latter half forms a basis for a legitimate use of inhibition. 



246 PRINCIPLES OF OSTEOPATHY. 

This phrase, ''remove lesions," is an osteopathic epigram. 
It has become so thoroughly ground into the mind of the 
student that he feels that no matter what the case, he must 
find a mechanical lesion and remove it in order to effect a 
cure. This is continually spoken of as especially scientific, 
and this feeling throughout the profession has headed off care- 
ful investigation in other phases of our work. 

There certainly is a wide held for the rational and scien- 
tific use of inhibition as a therapeutic measure in the treatment 
of disease. 

Osteopathic Meaning of Inhibition. — By the term in- 
hibition, we do not attempt to convey an}' other meaning than 
that of pressure, applied at some particular point on the surface 
of the body for the purpose of lessening the hyperactivity or 
hyperaesthesia of the immediate or some distant part of the 
body. The inhibition itself does in some cases remove what 
we may choose to call a lesion, in other cases it may make the 
removal of a lesion possible, but in the majority of cases its 
effect is purely on the nerves, thereby acting on both the motor 
and sensory portions of the reflex arc, lessening muscular con- 
traction and pain. 

The Scientific Use of Inhibition. — It has been proven 
many times that the osteopath is capable of checking excessive 
functional activity in viscera by the simple means of inhibiton. 
Some would quibble as to the cause of this activity. The 
original stimulus may have disappeared, but the reflexes which 
it initiated may be perpetuating the condition. Many cases 
have been treated in whch no definite cause or osseous lesion 
could be discovered. Some of these cases came under the 
heading, Indiscretions ; others under purely mental conditions. 
These cases were treated by inhibition based on a knowledge of 
the anatomy and physiology of the parts involved. The treat- 
ment was successful. We are sure that such successes are 
just as gratifying, just as scientific, as are those in which the 
finding and reducing of a subluxation brings the glow of tri- 
umph to the eye of patient and physician alike. 

Inhibition as a Local Anaesthetic. — Inhibition is a local 
anaesthetic, and as such is being used universally in the osteo- 



PRINCIPLES OF OSTEOPATHY. 247 

pathic profession today. True, it is not a treatment which will 
secure results in a minute. We can not inhibit for five minutes 
at the eighth dorsal spine in a case of malarial fever and expect 
to check the chill. The chill can sometimes be controlled as 
long as the inhibition is maintained. The influence thus gained 
over the muscular contractions seems to increase the patient's 
resistance. The onset of the next chill usually shows a de- 
crease in the intensity of muscular contraction, and the duration 
is shortened. No one would say that we remove a physical 
lesion by this treatment. Muscular contraction of the deep* 
dorsal muscles comes on with the chill, but does not cause it. 
Surely inhibition in this case works a nervous change of a 
pronounced character. 

Inhibition May Act Without Removing a Lesion. — In- 
hibition for the vomiting of pregnancy in no sense removes 
a lesion, and yet it has successes to its credit, surely the inhibit- 
ing influence exerted on the stomach is great, for it is able to 
overcome the reflexes from the pregnant uterus. 

The vomiting and purging of cholera morbus can be con- 
trolled by inhibition, and in this case there is probably an 
irritant to the intestinal mucosa in the form of indigestible 
food. The irritant is not removed by the inhibiton, but the 
excited stomach and bowels are given rest, and in consequence 
are able to carry on their functions properly. 

An example of the good results of inhibition is afforded 
by one of the author's cases. Woman, fifty years of age, suf- 
ered from diarrhoea, two years duration. Five to seven bowel 
movements daily. No formed feces. Usually the stools were 
typhoid in character. Uterine fibroid removed prior to devel- 
opment of diarrhoea. History of continuous drug treatment^ 
Osteopathic examination did not reveal any osseous lesion. 
There seemed to be nothing to lay the blame upon, except the 
once existent fibroid or the result of the operation. Since no 
definite lesion existed, the treatment was planned as a test of 
inhibition without any other method. At the end of three 
months the patient had but one movement daily, and the feces 
were well formed. Pressure and gentle stretching of the 
muscles extending over the area between the eighth dorsal and 



24S PRINCIPLES OF OSTEOPATHY. 

fifth lumbar spines constituted the methods used. From fifteen 
to twenty minutes was the duration of the treatment three 
times per week for two months and twice per week thereafter. 

In cholelithiasis the intense pain can be modified by inhi- 
bition at ninth and tenth dorsal spines, right side. Inhibition 
at this point also lessens the contraction of the abdominal 
muscles and thus makes direct manipulative treatment possible. 
The same is true in cases of appendicitis. YVe could not give 
direct manipulative treatment in such cases if it were not for 
the power of inhibition to lessen pain in the affected area and 
the consequent muscular contraction. How much more influ- 
ence is exerted over the nerves of the appendix and surrounding 
region, it is hard to say. It may be that the inhibition arouses 
other forces of a stimulatory character to be brought into 
action to empty the appendix. Direct manipulation in these 
cases is frequently out of the question. 

Inhibition to Remove Lesions. — Inhibition is a large 
and necessary part of many treatments given for the purpose of 
removing a definite lesion, for if inhibition were not first used, 
the true lesion could not be touched. This is the case in intes- 
tinal obstructions. The intestinal irritation causes such bowel 
contractions, cramps, and contraction of the abdominal muscles 
that the physician's fingers cannot palpate the disturbed area. 
Inhibition over the spinal area from which the nerves to the dis- 
turbed area pass out will cause relaxation of the muscles. 

In a case of pleurisy which came under the author's care 
an opportunity was afforded to test inhibition unhampered by 
any other method. The patient could not bear to have the right 
arm moved; respiration was exceedingly shallow, and the 
physical strength was very low. Hot fomentations had been 
used, but to lift the arm caused excruciating pain in the side. 
It was a case of dry pleurisy. Steady inhibition was given for 
fifteen minutes between the transverse processes on the right 
side in the area between the third and the seventh dorsal 
vertebrae. After this length of time the patient could raise the 
right arm above the head and take much better inspiration. 
As a result of this treatment given twice per day, the patient 



PRINCIPLES OP OSTEOPATHY. 249 

made a good recovery, though all the metabolic processes were 
carried on in a very unsatisfactory way. 

Passive Movements vs. Rest. — According to Hilton's 
ideas, as expressed in "Rest and Pain," any movement of the 
chest muscles would be contra-indicated on account of the pain 
which would be nature's method of enforcing rest necessary 
for the cure. The patient declared that the deadening of the 
pain and the consequent possibility of movement of the thorax 
seemed to revivify the entire system, as well it might on ac- 
count of the increased circulation and resultant activity of all 
vital processes. Hilton^s theories are certainly well sustained 
by his argument, but when we consider that he calls adhesion 
of tissues a cure, we are compelled to strive for different 
results. 

In chronic diseases one has ample opportunity to search 
for a definite lesion, but acute diseases usually demand rapid 
work, and one must be ready to meet the demands of the mo- 
ment. It is comparatively easy to theorize about osseous 
lesions here and there in acute diseases, but only those who 
have had opportunity know what it is to attempt to set sub- 
luxated ribs or vertebrae in cases of pneumonia or appendi- 
citis. 

If, as Hilton declares, the use of local anaesthetics over 
the termination of sensory nerves which are reflexly irritable on 
account of inflammation in the area of distribution of other 
nerves from the same segment of the cord, is a good treatment, 
then the use of inhibition as applied by the osteopath is surely 
more rational and scientific. 

Inhibition as a Preparatory Treatment. — There is still 
another time when inhibition is of incalculable value : In 
making examination of the vagina or rectum, especially the 
former. Several times, in the author's practice, examination 
of the vagina seemed impossible without great distress to the 
patient. The irritability of the mucous membrane of the 
vagina caused intense spasmodic contraction of the sphincter, 
but steady inhibition over the third and fourth sacral for- 
amina for about five minutes caused complete relaxation, and 
the examination could then be made without any trouble. 



2 5 o PRIXCIPLES OF OSTEOPATHY. 

Cases have been reported to the author by many osteopaths 
describing the good results of inhibition in gynecological cases. 
These cases have ranged from simple nervous vaginismus to 
curettement. Since the sacral nerves are so near the surface, 
and are not interrupted in their course to the pelvic viscera, they 
afford excellent opportunity for the good effects of inhibition 
to be demonstrated. 

We know from experience that osteopathy can do wonder- 
ful work in removing obstructions, and that it comes nearer 
to finding all these obstructions than any other school of prac- 
tice : but there are diseases not due to misplaced tissue. It 
behooves us to study how we can get results in those cases in 
which no physical lesion appears, and yet function is greatly 
changed. 



CHAPTER XIII. 



POSITIONS FOR EXAMINATION. 

In order to be systematic in the examination of patients, 
it is well to adopt the use of a certain routine of positions 
which will best show the details of osseous structure. 

Testing Alignment and Flexibility. — The first position, 
as illustrated in Fig. 90, flexes the spinal column and makes 
the spinous processes prominent. This position is valuable in 
examining even very fleshy people. Approximation or sepa- 
ration of the spines can be noted, also lateral deviation. If the 
amount of flesh over the spines, as in fat people, precludes the 
use of the sense of sight, you can ascertain the relation by the 
sense of touch. 

Sense of Touch. — I wish to emphasize the necessity of 
the students acquiring the habit of depending on the sense of 
touch, rather than of sight. In all osteopathic examinations, 
the sense of touch should be used to obtain those data concern- 
ing structure which form the basis of all diagnosis. Remember 
that you cannot see bone, muscles and glands, but you can 
feel them. 



PRINCIPLES OF OSTEOPATHY. 



251 



Wm 




1^ I 






■1 flBr 

SSifiSI IP pp '1|| 



F/£-. 90. — Flexion of the spine in the vertical position to make the spinous processes 

prominent. 

Inspection. — While the patient is sitting erect, ascer- 
tain the flexibility of the spinal column. Note the position of 
the scapulae, whether near or far from the spinal column, 
whether unevenly placed. Note the development of the trapa- 
pezius, latissimus dorsi, and erector spinae, i. e., observe their 
surface markings. 



252 



PRINCIPLES OF OSTEOPATHY. 




Fig. 91. — Position to accentuate the prominence of the ribs. 



Palpation of the Ribs. — Fig. 91 illustrates a method of 
bringing the ribs prominently into view, or in case of fleshy 
persons, makes it easy to palpate them. By pulling the arm 
up and across the chest, the latissimus dorsi is stretched which 
brings the four lower ribs into a good position for examination. 
The movement of the scapula away from the vertebrae makes 
it easier for the examiner to feel the angles of the fourth and 
fifth ribs. It is not well to depend on this position for evi- 
dence of rib subluxations, because the tension of the latissimus 



PRINCIPLES OF OSTEOPATH y. 



253 




Fig . 92. — Palpation of the spine in the vertical position. 



dorsi brings at least the four lower ribs into proper alignment. 
The spacing of these ribs will then be equal. 

The chief value of this position is to give the examiner 
better opportunity to palpate the angles of the ribs above the 
ninth and to note the changed relations which may take place at 
the anterior end of the ninth, tenth, eleventh and twelfth ribs. 

Palpation of the Spine. — After gathering as much in- 
formation as possible by observing the form of the back, posi- 



254 PRINCIPLES OF OSTEOPATHY. 

tion of the scapulae and contour of the muscles, examine the 
spine by means of your sense of touch. To do this, have the 
patient sit erect, being careful not to exaggerate the normal 
posture, i. e., bend the spine far forward or backward in the 
lumbar region. A marked tendency to either position is indica- 
tive of weak muscles. Use the index and middle finger of 
either hand to carefully note the relations of the individual 
vertebrae, as in Fig. 92. Begin at the first dorsal and work 
downward to the sacrum. Lateral subluxations are easily 
noted with the patient in this position. Gentle digital pres- 
sure may be made at the prominent side of any subluxated 
vertebra to determine the degree of sensitiveness. This infor- 
mation is best secured when the patient is reclining, because the 
muscles are relaxed. While the patient is sitting there is 
usually too much contraction of both intrinsic and extrinsic 
muscles of the back to allow much examination outside of mere 
study of alignment and normal or abnormal curves. 

Now have the patient recline on the right or left side, 
which is most convenient, as in Fig. 93. Examine the condi- 
tion of the spinal muscles by using the ball of the fingers of 
one, or both hands. Be careful not to use the ends of the 
fingers. Commence your examination at the first dorsal by 
noting the amount of sensitiveness directly on or between the 
spinous processes all the way to the coccyx. To elicit this 
sensitiveness use a moderate pressure, equal to about six 
pounds. With this much pressure the patient will be able 
to distinguish easily between the sense of mere pressure and a 
painful or hyper-sensitive feeling. 

Begin once more at the first dorsal and examine along the 
sides of the spines and about three inches from them. This 
space brings the internal and middle groups of intrinsic muscles 
under your fingers. 

Extrinsic and Intrinsic Muscles of the Back. — In 
speaking of extrinsic and intrinsic muscles of the back, we 
desire you to bear in mind the different groups as they are 
noted in Gray's Anatomy. Gray divides them into five layers. 
The first three layers are extrinsic, i. e., arise from vertebrae 
and insert into the humerus, scapulae, or ribs. They depend 



PRINCIPLES OF OSTEOPATHY. 



255 




Pig- 93 — Palpation of the dorsal muscles — horizontal position. 



upon the intrinsic muscles of the fourth and fifth layers to fix 
the spine so that operating from the spinal column as a fixed 
point, they can move the upper extremities and ribs. 

While palpating a back which is moderately well muscled, 
you will be able to feel through the upper three layers and 
distinguish the condition of the muscles of the fourth layer. 
It is important that the student should learn to feel through 
the soft tissues to harder ones below. Skill in detecting vary- 
ing degrees of density and hardness is an absolutely essential 
qualification of the diagnostician. 

A careful dissection of the fourth layer will disclose the 
fact that there are three parallel groups of muscles. The first 
is the spinalis dorsi which lies on the side of the spines. The 
second group lies more on the transverse processes. The lon- 
gissimus dorsi and its continuations make up this group. The 



256 



PRINCIPLES OF OSTEOPATHY. 




, * 







v 



F*£-. 94.— Diagram of dorsal muscles— ist, 2nd, 3rd and 5th layers. 



PRINCIPLES OF OSTEOPATHY. 



257 







Fig- 95- — Diagram of dorsal muscles — 4th layer. Adapted from a diagram in Cunning- 
14 ham's Anatomy. 



258 PRINCIPLES OF OSTEOPATHY. 

sacro-lumbalis and continuations make up the third group 
which lies on the angles of the ribs. Careful palpation will 
distinguish these divisions. 

The Diagnostic Value of Hyperaesthesia. — Different 
points, along the line of the first group, which are hyper- 
sensitive may be evidence of direct strain of a single vertebral 
articulation, or the result of a visceral reflex, or even in sym- 
pathy with a rib subluxation which affects sensory nerves 
reaching the same segment of the cord from which its nerves 
arise. Hyperaesthesia directly upon the spines is usually found 
in connection with depression or elevation of the spines, not 
lateral subluxation. 

Hyperaesthesia at points in the second group of muscles, 
i. e., the longissimus dorsi and continuations over the trans- 
verse processes, may result from vertebral or costal subluxation, 
or muscular contraction caused by visceral reflex. 

When this excessive sensitiveness is found at the angles of 
the ribs in the short muscular divisions of the sacro-lumbalis 
and continuations, it nearly always signifies an irritation from 
a costal subluxation. 

The examination of the ribs should be made while the 
patient is in this reclining position. The fingers should follow 
the angles of the ribs, noting the spacing, special prominence 
or depression of an angle, then noting the compensatory 
changes at the chondro-costal articulations. In this way the 
relation of the ribs to each other can be determined. 

When pain exists at any one of the points named, or the 
digital pressure arouses a painful reflex, all of the sensory 
points along the course of the spinal nerve should be tested in 
order to determine the extent of the nerve irritation. Take for 
example, the point on the spinal column between the fifth and 
sixth dorsal. After examining these two spines and finding 
them well placed, our digital pressure at the sides might cause 
a painful reflex, i. e., the patient might complain of our pres- 
sure. Then we test the point over the transverse processes 
and angles of the ribs, and even the junction of the ribs and 
costal cartilages. If hyperaesthesia is present at all points in 
the distribution of the fifth spinal nerve, we understand that 



PRINCIPLES OF OSTEOPATHY. 259 

the original irritation may be slight, but long continued, or 
strong and of short duration. If no osseous displacement is 
discoverable which has a relationship with a hypersensitive 
nerve, we must' look for evidence of disturbed functioning by 
the viscus most nearly related. The original irritation might 
have been an excessive demand on the ability of the viscus as 
in the case of the stomach being overloaded. 

In any case, the discovery of what appears to be an osseous 
lesion, leads us to test the condition of its related nerves. If 
they do not show undue excitability, the lesion is doubtful 
as a causative factor. A careful examination of vertebral 
spinous processes may show many deviations from symmetrical 
development, and the diagnostician should guard against the 
false evidence of these distorted spines. If a spine has been 
distorted by unequal development, there should be no sensi- 
tiveness around it except as the result of a visceral reflex. In 
case of such visceral reflex, the examiner cannot help being 
misled as to the value of the apparent osseous malformation. 
His fingers cannot inform him that what he considers an 
osseous lesion is in reality bad development. The only way 
he can escape from making a mistake is by continuing his 
examination without holding a positive idea that he has found 
the cause. The history and development of the case may 
arouse strong doubts as to the value of his discovered spinal 
lesion. 

Your attention is called to this possible mistake in valua- 
tion of a lesion so that you may not become wedded to the 
idea that when you have found what appears to be a mis- 
placement, you are free to end your examination and pro- 
nounce a competent judgment. 

Test Muscular Tension. — While the patient is on his 
side, examine carefully the amount of tension in these three 
groups constituting the fourth layer. After considerable edu- 
cation of the sense of touch, it will be possible for you to deter- 
mine that the points under your fingers are probably too sensi- 
tive. When these muscles feel hard and unyielding, they are 
usually sore to pressure. The contractured condition of the 
muscle has affected the sensorv nerve filaments in two ways : 



26o 



PRINCIPLES OF OSTEOPATHY. 



First, by direct pressure between the contracted muscle bun- 
dles ; second, by retention of metabolic waste products which 
result in chemical poisoning. 

Thoracic Flexibility. — Fig. 96 illustrates a method of 
ascertaining the elasticity of the dorsal spine and thorax. 
This procedure assists in estimating the general condition of 




Fig 96. — Testing the pliability of the interscapular portion of the spinal column. 

the body. If the thorax is fixed, inelastic, respiration cannot 
be carried on properly. Oxygenation of the blood will be im- 
perfect. 

Examination of the Abdomen. — Fig. 97 shows the 
proper position of the patient for examination of the abdomen. 
The knees being drawn up allows relaxation of abdominal 
muscles. Where the abdomen is very sensitive to the touch, 
either because of pain or ticklishness, use the whole hand until 
the patient becomes somewhat accustomed to the touch. Some- 
times it is necessary for the physician to lift the feet from the 
table and flex the knees quite close to the abdomen. A steady, 



PRINCIPLES OF OSTEOPATHY. 



261 



even pressure of the hand on the abdomen will soon become 
non-irritating to the patient, and deeper palpation can be made. 
If the examination is a general one, commence your work, 
with the patient in this position, by palpating the thorax. Note 
form and flexibility, especially the flexibility of the five lower 




Fig. 97. — Palpation of the Abdomen. 



ribs. The free movement of these ribs is essential to many 
functions, chiefly respiration, but it also affords a sort of 
rhythmical massage to the liver and stomach. 

Such observations of form and flexibility are very general, 
but they lead invariably to some clue of especial value in the 
search for effects and their causes. 

Elevation or Depression of Ribs. — Note the spacing of 
the ribs to determine whether any rib is elevated or depressed. 
Palpate the chondro-costal articulations for misplacements, 
especially note the articulations of the tenth ribs, they are fre- 



262 



PRINCIPLES OF OSTEOPATHY. 



quentiy broken loose and form additional floating ribs. They 
are usually depressed slightly under the ninth. 

After palpation of the chest, use percussion, then ausculta- 
tion, according to the methods outlined in the best text-books 





Fig. 



-Position for examination of the prostate gland. 



on diagnosis. By the use of all these physical methods it is 
possible to arrive at a very definite conclusion of the state of 
the thoracic viscera. 

The abdomen should be palpated, then percussed. These 



PRINCIPLES OF OSTEOPATHY. 



263 



two methods should make evident any organic change in the 
abdominal viscera. 

Examination of the Rectum and Prostate Gland. — Fig. 
98 illustrates a position for examining the rectum and pros- 
tate gland. Fig. 99 is the well-known Simm's position which 
may be used for the same purpose as the preceding. 

Other positions used by the osteopath for examination and 
treatment are the well-known gynecological positions, genu- 
pectoral and Trendelenburg. 




Fig. 99. — Simms' position. 



After the trunk has been examined in these various posi- 
tions, the neck requires attention. 

Examination of the Neck. — For easy examination of 
the neck, the patient should be recumbent, as in Fig. 97. The 
muscles of the neck must have all tension removed so that the 
examiner's fingers can feel the processes of the cervical verte- 
brae. 

A flat table instead of the model shown in the illustration 
is better. A hard small pillow may be used to support the head. 

Since the spinous processes in the cervical region are short 
and bifid, and oftentimes developed unevenly and are covered 



264 PRINCIPLES OF OSTEOPATHY. 

with several layers of muscles and ligaments, it is not satis- 
factory to use them as land marks for relations of cervical 
vertebrae. 

The tubercles on the transverse processes are easily pal- 
pated, hence these serve as guides in the detection of slight 
misplacments of cervical vertebrae. 

The transverse processes of the atlas are usually large and 
sufficiently prominent to enable the examiner to ascertain accu- 
rately its position. When the atlas is in its true position, its 
transverse processes will be found about midway between the 
mastoid processes of the temporal bones and the angles of the 
jaw. This relationship may appear untrue when the mastoid 
processes are 'quite large or small, or the angles of the jaw are 
more or less obtuse. It is necessary to study the relative de- 
velopment and positions in every case, on both sides, in order 
to discover whether a subluxation exists. The fact that nearly 
all subluxations of the atlas are twists instead of direct forward 
or backward displacements, makes it comparatively easy to 
detect the inequalities and understand the faulty position. 
Sensitiveness will be found in the tissues on the side whose 
transverse process is posterior. In case there is marked sensi- 
tiveness on both sides, that is, on the posterior surfaces of 
both transverse processes, the atlas is probably drawn slightly 
posterior on both sides by the severe contraction of its attached 
muscles. 

The third cervical vertebra seems to be easily subluxated. 
It is usually twisted, not sufficiently to lock its articular pro- 
cesses, but just enough to make the dorsal surface of its infe- 
rior articular process easily palpable through the muscles which 
lie over it. This prominent point will be sensitive because the 
muscles over it are always tense. 

Sometimes the sixth cervical vertebra is twisted. When 
this condition exists, there is marked disturbance of circulation 
in the head. The patient is usually wakeful and excitable on ac- 
count of the congested condition of the cerebral blood vessels, 
caused by the pressure on the vertebral veins. 

Note the tone of all the cervical muscles, the flexibility of 
the neck, the temperature of the skin on different parts of the 



PRINCIPLES OF OSTEOPATHY. 265 

neck. Palpate the chains of lymphatic glands, the thyroid and 
the submaxillary salivary glands. 

After a thorough palpation of the neck, look carefully for 
any evidences of disturbed circulation in the head as may be 
evidenced by the appearance of the skin, mucous membrane of 
the mouth, the tonsils, conjunctiva or the wearing of glasses. 
Your knowledge of optics should enable you to judge the 
condition of the eyes by inspection of the glasses worn. 

Such an examination of the head and neck as herein out- 
lined should give the examiner a good understanding of the 
structural and functional condition existing at the time of 
examination, and even guide him to what other parts of the 
body may need special attention. 

The History of Lesions. — All structural and functional 
facts determined by your examination are historical, that is, 
they have dates and circumstances which give them much or 
little value. The experienced diagnostician delights in filling 
in the life history of the patient to fit the structural and func- 
tional changes. Herein lies the opportunity for the physician 
to bring to his aid all his resource of experience and educa- 
tion in judging how these lesions have been brought about 
and how they are now influencing other tissues. 

The Extremities. — While the patient is in the recum- 
bent dorsal position, Fig. 97, the lower extremities can be 
examined. Note the comparative length of the legs, but be 
careful to eliminate all possibility of mistake by observing 
whether the patient is lying evenly on the back, ilia same 
height, and muscles of both legs equally relaxed. A measure- 
ment from the anterior superior iliac spine to the internal mal- 
leolus determines the length of the leg. 

Palpate the great trochanter. Note its relation to Nela- 
ton's line. These general directions for examination will de- 
termine the weak, disordered or diseased part of the body 
which requires your further careful examination. 

Subjective Symptoms. — You willl observe that thus far 
nothing whatever has been said about asking the patient con- 
cerning his or her subjective symptoms. It is a general prin- 
ciple underlying osteopathic diagnosis that objective symptoms 



266 PRINCIPLES OF OSTEOPATHY. 

are the only true facts upon which the diagnostician dares base 
his judgment and final verdict. The nearest approach to a 
subjective symptom thus far mentioned is hyperaesthesia. This 
may frequently be judged by the feeling of the muscle when 
pressed upon by the fingers. The muscular reaction to the 
painful sensory impressions occasioned by the pressure can be 
felt. Usually we depend upon the patient to indicate or cor- 
roborate our sense of touch. 

In actual practice this process is not carried out in its 
entirety. Time is a factor in the physician's life as well as in 
the life of the business man. He cannot afford to go about his 
work in this detective-like manner. It requires too much time. 
We hear a great deal of objection to the physician's question to 
his patient : "What is your trouble ?" But the answer to it 
enables him to get quickly to work on the seat of disease or at 
least leads him quickly to it. The physician who is a good 
questioner saves much time. He does not accept the subject- 
ive symptoms, merely goes to work to prove or disprove their 
verity by the standards of physical diagnosis. 



CHAPTER XIV. 



MANIPULATION. 

After an examination has resulted in the location of a 
lesion, it is necessary to consider the therapeutic methods for 
correcting it. The lesions which are discovered may be osse- 
ous, muscular or ligamentous, resulting in the perversion of 
some physiological process, such as an increase or decrease 
of blood supply or secretion, etc. The symptoms of the case 
are only surface evidence of disturbances of structure. The 
examiner must not be misled by symptoms ; more than this, 
he must not let symptoms claim his whole attention when ad- 
ministering his therapeutics. 

Methods of Procedure. — Osteopathic physicians fre- 
quently differ as to methods of procedure, but they all work 



PRINCIPLES OF OSTEOPATHY. 267 

according to the same principle. For instance, a subluxation 
of a vertebra might be discovered by two osteopaths. The 
first one might undertake to reduce the subluxation without 
any preliminary work on the muscles, believing that it is best 
to go right to the seat of trouble and remove it. His treat- 
ment would be severe because much strength would be re- 
quired to overcome the resistance of the muscles governing 
the articulation. The second one might spend considerable 
time on the preliminary work of relaxing the muscles of the 
articulation, increasing flexibility, reducing sensitiveness, etc., 
before attempting any specific reduction of the lesion. The 
ultimate result of both methods would be alike. The question 
of which method is best lies wholly with the individual osteo- 
path. Some like to put forth a severe effort for a short time, 
others a moderate effort for a longer time. Outside of the 
special choice of the osteopath, lies the business one of satisfy- 
ing the patient. Severe work at the outset frightens some 
patients, furthermore, it actually bruises some of them. The 
ultimate result of the treatment may be excellent, but the pa- 
tient does not quickly forget the methods used. There is a 
parallel between the immediate after-results of a severe osteo- 
pathic treatment and surgical shock. This shock should be 
avoided as much as possible. 

The movements hereafter pictured and described are all 
made with reference to structure rather than function. Few 
references are made concerning their applicability to special 
diseases. We do not care what the name of the disease is. 
The groups of symptoms which make up the pictures described 
in symptomatology have very little significance to the osteo- 
path. His movements are not made with reference to a named 
disease, but to a faulty structural condition. The structural 
condition may be the basis for the physiological. Function 
does affect structure, We are not to lose sight of this fact. 
Function may be perverted by bad habits, hence our therapeu- 
tics must comprehend the hygienic and dietetic side of life as 
well as structural. 

Each movement herein outlined secures a definite effect 
on a muscle, or is used to affect the relation of bony parts. 



268 



PRINCIPLES OF OSTEOPATHY. 



The movements made to affect the muscles of the back 
and spinal column are based upon the attachment of the mus- 
cles and the leverage they exert on the spinal column. 

Relaxation of the Latissimus Dorsi. — The arrangement 
of the back muscles has been noted in the chapter on Positions 
for Examination. In order to relax these muscles in their 




Fig ioo. — Relaxation of the latissimus dorsi 



natural relations, i. e., from superficial to deep groups, we 
begin with such a movement as will separate the extremities 
of the most superficial muscles to their fullest extent. Fig. ioo 
illustrates the method of relaxing the latissimus dorsi. One 
hand extends the arm to its fullest extent, the other hand an- 
chors the ilium. It will be noted that the lower dorsal and 
lumbar portions of the spinal column are lifted by the pull 
of this muscle. Also the four lower ribs are raised. The 



PRINCIPLES OF OSTEOPATHY. 269 

intrinsic effect of this stretching movement is to take most 
of the tension out of the muscle itself and increase the amount 
of metabolic change taking place within it. But that is not 
what is primarily intended. The intrinsic effects are mere 
incidents in the physiological life of the muscle, and as such 
are found following all kinds of muscular movements. The 
extrinsic effects are what concern us most ; the effect upon 
the vertebrae and ribs, the change in the form of the chest. 

There are three uses for this movement. First, as pre- 
paratory to work upon muscles lying beneath it, i. e., purely 
relaxing. Second, in case of overlapping by any one of the 
four lower ribs. It is a common condition to find the twelfth 
rib under the eleventh, or tenth under eleventh. The pull of 
the latissimus dorsi is exerted on all alike, hence the individual 
ribs are brought into their proper relations. Relaxation usually 
allows a return of the faulty position, but if the ribs are held 
at their extremities by the operator for a few seconds after 
relaxation, the intercostal muscles and quadratus lumborum 
will be filled with arterial blood which tones them. The patient 
should be directed to hang by the hands several times per day 
so as to get the good effect on the position of the lower ribs. 
Third, to affect lateral curvature of the spine in the lumbar or 
lower dorsal portion. 

Relaxation of the Trapezius. — The trapezius is another 
of the superficial group of back muscles. Its fibres are so vari- 
ously attached that several movements are required to relax 
all its divisions. Fig. 101 illustrates the method of grasping 
and holding the scapula while relaxing the trapezius. The 
scapula is rotated on the thorax as far as possible toward the 
head so as to stretch those fibres extending from the spine 
of the scapula to the sixth and twelfth dorsal spines; then 
away from the head to affect the cervical fibres, then away from 
the spinal column to relax the short fibres between the upper 
dorsal spines and scapula. There is a vast difference in the 
way the scapula can be moved about in different cases. Those 
having any tendency to asthmatic trouble will present a very 
fixed scapula. The more marked the asthmatic condition is, 
the more difficult it is to move the scapula. Pleurisy and lung 



270 PRINCIPLES OF OSTEOPATHY. 

troubles, especially when coughing is frequent, tend to hold 
the scapula fixed. Lifting the patient's body above the table 
by the scapula gives instant relief in many cases of pleuritic 
pain, intercostal neuralgia or angina pectoris. This result is 
explained by the removal of the pressure exerted by the scapula 
when it is held too close to the thorax bv contracted muscles 




Fig. 1 01. — Relaxation cf the trapezius. 

which are acting reflexly. A subluxated rib is usually respon- 
sible for the pains mentioned, but the muscles of the scapula 
are partially respiratory, hence act in connection with disturb- 
ances of normal rhythm of intercostal muscles. The pres- 
sure of the scapula helps to fix the whole chest in an unyield- 
ing condition. That which was at first purely helpful in char- 
acter becomes in itself an added irritant. 



PRINCIPLES OF OSTEOPATHY. 



271 



This movement or series of movements affects the tone of 
the muscle fibres, then the whole respiratory process. 

Relaxation of the Rhomboids. — In the second group of 
back muscles we find the rhomboids, major and minor, acces- 
sory muscles of inspiration. Fig. 102 illustrates a method of 




Fig. 102.- — Relaxation of the rhomboideus major and minor. 



stretching these muscles. The patient's elbow is placed against 
the physician's abdomen. Pressure against the elbow forces 
the scapula back, and makes its vertebral border prominent. 
The physician's fingers grasp this border securely, and then 
lift steadily upward. This movement is excellent for the pur- 
pose intended. That which has been written concerning the 
trapezius is applicable to the rhomboids. Outside of the in- 



272 



PRINCIPLES OF OSTEOPATHY. 



trinsic effects on the muscle and on respiration, a slight effect 
may be exerted on a lateral curve in the interscapular region. 
It is generally used as preparatory to work on deeper struc- 
tures. 

The Pectoralis Major and Serratus Magnus.- — Following 
these movements, where general thoracic and spinal relaxation 




Fig. 103. — Relaxation of the pectoralis major and serratus magnus. 



are desired, the movement illustrated in Fig. 103 may be used. 
It affects the Pectoralis Major and Serratus Magnus. By 
pushing the patient's elbow as far back as possible, the scapula 
is approximated to the spinal column, hence the serratus mag- 
nus is put upon a tension which lifts the eight upper ribs. The 
pectoralis major also affects the upper ribs. The phy- 



PRINCIPLES OF OSTEOPATHY. 



273 



sician's hand on the angles of the ribs accentuates the ex- 
pansion of the chest. This is a general movement, but one 
which has far-reaching effects upon respiration and circula- 
tion. It is adaptable to many specific structural defects of the 
ribs. 

In Fig. 104 the physician again uses the humerus and 
scapula as means by which to affect the spinal column. The 




Fig 



-Relaxation of the serratus magnus and some fibers of the fourth layer 
of dorsal muscles. 



left hand exerts traction on the muscles above the spine, while 
the right hand and arm forces the patient's scapula toward the 
head and spine. The movement is made to enable the physi- 
cian to relax the serratus magnus and some of the fibres of the 
fourth layer of the back. Slight torsion of the dorsal spinal 
column is also secured. 

Quadratus Lumborum. — The relaxation of the quad- 
ratic lumborum is secured according to Fig. 105. In all dis- 
placements of the twelfth rib, it is necessary to secure a free 



274 PRINCIPLES OF OSTEOPATHY. 

circulation in the muscles attached to that rib. The fact that 
it is a floating rib makes its position dependent on the tone of 
the muscles attached to it. It is frequently slipped under the 
eleventh. This movement separates them. 

Fig. 1 06 is in some respects similar to the movement illus- 
trated in Fig. 104, except that the scapula is forced downward, 




Fig. job- — Relaxation of the quadratus lumborum. 

and the left hand is able to work through the relaxed super- 
ficial muscles. After the use of the movements already illus- 
trated, it is astonishing how easily one can work upon the 
fourth layer or examine the condition of deep structures. 

Erector Spinae. — The work upon the fourth layer 
should be done according to Fig. 93. The fingers are placed 



PRINCIPLES OF OSTEOPATHY. 



275 



between the muscles and the spines of the vertebrae and then 
drawn away from the spines in such a manner as to stretch the 
muscles. The fingers should never be allowed to slip over the 
muscles. Work steadily and deeply. Do not move the fingers 
over the skin. When you place your fingers, compel all soft 
tissues beneath them to move with them. In this way you 
secure relaxation of the erector spinae and continuations, take 
out soreness of the muscles, and prepare for specific work upon 
the ribs or vertebrae. 




Fig. 106. — Relaxation of the lower fibers of the trapezius. 

The erector spinae is rarely contracted throughout its 
whole length. Your work should be centered on that portion 
which your examination has demonstrated to be contracted, 
either as a result of visceral disturbance, osseous subluxation, 
strain or cutaneous reflex from cold. 

Having now prepared our patient for specific manipulation, 
we will note the results to be obtained on the general contour 
of the spinal column. 

Treatment of Simple Kyphosis. — Fig. 107 illustrates 
one of the simplest methods of springing a spine which is 



276 



PRINCIPLES OF OSTEOPATHY. 



kyphosed at the junction of the dorsal and lumbar. The phy- 
sician's forearms are placed against the patient's shoulder and 
ilium while the fingers rest over the kyphosed portion of the 
spinal column. The hands draw forward while the forearms 
push away. Considerable force can be exerted in this way 
on slender patients. 




Fig. 



-A method of springing a dorso-lumbar kyphosis. 



Great force can be exerted on a posterior curve of the 
lower dorsal and lumbar portions by the movement shown in 
Fig. 108. This movement is also used for purposes other than 
corrective of structural defects. Since the leverage is so great, 
it is quite easy for the physician to carry it too far. The re- 
sult is an active congestion of the lower portion of the spinal 
cord followed bv excessive activity of the nerve centers located 



PRINCIPLES OF OSTEOPATHY. 277 

there. In giving this movement to women, ascertain whether 
pregnancy exists. If so, do not under any consideration use 
it. The center for parturition might be excited by it, even 
though the movement made is slight. 

There is practically no danger in this movement when in- 
telligently used, except in the case of pregnancy. A slow, 
steady lift made while the physician is watching carefully the 
amount of resistance offered by the back will usually inhibit the 
excitement of the centers located in the lumbar enlargement of 
the spinal cord. The slowness and steadiness of the move- 




Fig. 108. — A method of springing a lumbar kyphosis. 

ment relaxes the muscles of the fifth layer and secures better 
drainage for the blood in the spinal canal. No active congestion 
is brought on, hence a sedative effect is gained. Quick, in- 
tense execution of this movement has frequently a reverse 
effect, because the sharp strain put upon the muscles results in 
added contraction, active congestion and obstruction to good 
drainage of the spinal canal. These conditions result in func- 
tional activity of those organs governed b}^ the nerve-cells in the 
lumbar enlargement. Active congestion of a center results in 
increased function of the organ governed by that center. 

As a general rule, this movement is contra-indicated for 



27& 



PRINCIPLES OF OSTEOPATHY. 



any purpose but that of correcting a structural defect. The re- 
action of many patients is an uncertain quantity, hence it is not 
wise to use this treatment for purely functional effects. 

As a result of the ignorant use of this movement by those 
who are palming themselves off as osteopaths, the author knows 
of several cases where dangerous conditions were brought on. 




Fig. 109. — A method of springing an upper dorsal lordosis. 



Lordosis — Upper Dorsal. — An anterior curve or 
straightened condition of the spine in the interscapular region is 
rather difficult to treat on account of inability of the physician 
to use the extremities as levers. Fig. 109 illustrates a method 
of applying leverage by means of the cervical vertebrae. The 
position of the knee on the spinal column regulates the extent 
of the force of the movement. The knee is the weight to be 
lifted, the spinal column is a flexible lever. The physician's 



PRINCIPLES OF OSTEOPATHY. 279 

forearms are the fulcrum, while his hands apply the force to lift 
the weight (the knee) which bends the lever at the point gov- 
erned by the position of the weight and fulcrum. The position 
of the physician's hands is important, because the cervical is not 
the portion of the spinal column we desire to bend. If the 
hands are allowed to rest close to the head, the force exerted is 
nearly all spent on the neck ; the most flexible part of the spinal 
column is affected — a result not desired. Place the hands as 
nearly over the cervical and 1st dorsal spines as possible. Since 
the junction of the dorsal and lumbar segments is a very flex- 
ible point, the knee should be located higher. 

The Possible Variety of Movements Which Will Se- 
cure the Same Results. — All of the effects described may 
be secured by movements differing from those outlined. The 
author desires to illustrate the application of osteopathic prin- 
ciples. It is believed by him that the series of movements illus- 
trated have the virtue of directly and forcibly affecting the part 
desired without using up too much of the physician's strength 
in their application. Where much work is done by a physician, 
it becomes a vital problem with him how to conserve his own 
strength. By the selection of those movements which give the 
greatest leverage, he saves himself. 

The Head and Neck as a Lever. — If the anterior or 
straightened condition of the spine is very marked in the upper 
dorsal, it is possible for the physician to use the head and neck 
in securing his leverage. When the position of the spine is as 
described, the spinal muscles in that area will be very con- 
tracted. The vertebrae will be held tightly together, thus lessen- 
ing the flexibility. Loss of flexibility of the' spinal column re- 
sults in poor circulation in the spinal cord with consequent per- 
version of the activity of the physiological nerve centers located 
there. Congestion, passive type, usually exists around these 
centers when drainage is interfered with by these contracted 
muscles. The nerve centers manifest their irritation by such 
conditions as bronchitis, pleurisy, etc., that is, a congestion 
exists at the peripheral distribution of the nerve similar to that 
at its origin. 

Lordosis or Kyphosis May Affect a Function Similarly. 



280 PRINCIPLES OF OSTEOPATHY. 

— A change in the contour of the spine, either anterior or pos- 
terior, may result in the same disturbances in the peripheral dis- 
tribution of the nerves from the distorted section. The anterior 
curve in the interscapular region usually causes the ribs to 
droop, which occasions a flat chest. The thoracic cavity is 
lessened, hence respiration is feeble. People with flat chests 
may develop wonderful breathing capacity by persistent exer- 
cise. The respiratory muscles lift the ribs. Exercise of these 
muscles will increase the antero-posterior diameter of the chest. 
When directing a patient about the details of exercise to in- 
crease the breathing capacity, do not fail to impress the fact that 
a full round chest without flexibility is just as bad a condition 




dorsal lordosis. 



as an abnormally flat chest. Flexibility is the keynote of health. 
Those exercises which merely increase the contracting power 
of muscle, without at the same time increasing their relaxing 
power are not healthful. 

Examination shows that whether we have anterior or pos- 
terior conditions in the interscapular region, the spinal muscles 
are contracted. The patient's power to relax them is lost. 
The patient may feel tired and weak, but these muscles will 
not cease their contraction. The rigidity has passed beyond 
the patient's control. 



PRINCIPLES OF OSTEOPATHY. 



281 



The patient can do something toward restoring flexibility 
to an anteriorly curved or straight spinal column in the upper 
dorsal region. Fig. no illustrates the effect of flexing the 
neck forcibly by pulling down with the hands. These spines 
are greatly separated, and hence the muscles of the fourth and 
fifth layers are relaxed. 



Fig. 




ead and neck as a flexible lever to affect the 
upper dorsal region. 



Fig. in illustrates how the physician can use the dorsal 
and cervical vertebrae as a flexible lever, and by shifting the po- 
sition of the hand upon the spine apply the movement specific- 
ally to any particular vertebra. No movement which uses the 
arms as levers will affect the position of these vertebrae, be- 
cause the first and second layers of muscles which are affected 
by arm movements do not control the intrinsic mobility of this 
portion of the spinal column. The fourth and fifth layers of 



282 



PRINCIPLES OF OSTEOPATHY. 



back muscles are the groups which cause the mal-position of 
vertebrae in this region. 

Splenius Capitis et Colli. — The Splenitis Capitis et 
Colli, a muscle of the third group, extends as low as the sixth 
dorsal spine. As its name indicates, it is a bandage muscle, 
and binds down the muscles tinder it. Its long attachment in 
the dorsal region gives it a considerable influence there, when 
its superior attachments to the head and neck are forced an- 




Fig. 112. — A method of affecting kyphosis in the upper dorsal region. 



teriorly by flexion of the neck. It is the influence of this mus- 
cle which makes the movements described so effective. These 
movements are for a general corrective effect on a section of 
the spinal column. They are not well adapted to treatment of 
an individual vertebra. 

Kyphosis — Upper Dorsal. — A posterior curve in the 
upper dorsal region can be treated by the method illustrated in 
Fig. 112. The physician's right arm is placed above the pa- 
tient's right shoulder and tinder the chest, so that the hand can 



PRINCIPLES OF OSTEOPATHY. 




Fig. 113. — A method of affecting kyphosis in the dorso-lumbar region 

be placed in the patient's left axilla. The patient's head should 
be turned away from the physician, so that the upward pressure 
of his arm will not interfere with the trachea. The physician's 
left hand may be moved from place to place along the spinal col- 



284 



PRINCIPLES OF OSTEOPATHY. 




Fig. 114. — A method of affecting kyphosis in the lower dorsal region. 

umn. The farther the hands are separated, the more leverage 
is gained. Considerable force can be exerted in this movement 
without any danger to the patient, in fact to be of any value it 
must be made forcefully. The primary use of this procedure 
is to reduce the excess of posterior curve. 



PRINCIPLES OF OSTEOPATHY. 



285 



That which has been written concerning the nerve centers 
in the interscapular region when straightening or anterior 
curvature of the spine exists, applies equally to the posterior 
curvature. 

Posterior curvature is accompanied by increased antero- 
posterior diameter of the chest, and loss of flexibility. This 
movement increases flexibility. It can easily be adapted to the 
treatment of the fifth or sixth ribs. 




Fig. 115. — A method of affecting kyphosis in the lumbar region. 



Kyphosis — Dorso-lumbar. — When the kyphosis is at 
the junction of the dorsal and lumbar regions, it is easy to 
secure enormous leverage. The arms can be used as levers 
while the physician's knee rests against the kyphosis as in Fig. 
113. If the patient's buttocks are held to the stool, the whole 
force of the leverage is spent on the back under the physician's 



286 



PRINCIPLES OF OSTEOPATHY. 



knee. This movement should not be carried too far. It, like 
all other movements in which the physician has tremendous 
leverage, is liable to produce more than the desired effect. It 
stretches the thorax and abdomen very decidedly. 

Contra-indications. — The author expects that all who 
use this and other high power movements, have examined 
their patients carefully before administering them. The 




Fig. 116. — A method of affecting either lordosis or kyphosis in the lumbar region. 



presence in the abdomen of an aneurism, ovarian cyst, or 
gravid uterus, contra-indicate the use of any movement which 
compresses the abdominal contents, and also in the case of a 
gravid uterus any movement which is liable to cause active 
congestion of the lumbar enlargement of the spinal cord. 

Other Movements. — Fig. 114 illustrates another meth- 
od of exerting pressure on the prominent part of a kyphosis. 
The leverage is not so great as in the preceding method, but 
where the kyphosis is slight, it is the better movement. 

Still another simple method of springing the lumbar por- 



PRINCIPLES OF OSTEOPATHY. 



287 



tion of the spinal column is shown in Fig. 115. The patient's 
knees are held against the physician's abdomen, while the 
physician's hands make counter pressure over the apex of the 
kyphosis. The buttocks are forced backward by the pressure 
on the patient's knees. Some osteopaths object to this move- 
ment or anv other which necessitates pressure of the patient's 




Fig. 117. — A method of securing general dorsal rotation. 



knees or elbows against the abdomen. There is an element 
of danger to the osteopath. 

This position, Fig. 115, is used frequently where strong 
inhibitory pressure in the lumbar region is required. For 
example, in cases of diarrhoea or cramps. Any hyperactivity 
of structures governed by cells in the lumbar enlargement 
may be inhibited in this region. 



288 



PRINCIPLES OF OSTEOPATHY. 




Fig. 



A case of uncompensated lateral curvature. 



When lordosis of the lumbar region exists, it is neces- 
sary to flex that region in order to counteract it. Fig. 116 il- 
lustrates an easy method of accomplishing this result. 

This same movement with the physician's right hand 
under the spine can be made to do duty in correcting a pos- 
terior curve. When the hand is placed directly under the 
kyphosis, the back is lifted ; then if the buttocks be forced to 
the table, the spine will be sprung in the direction desired. 



PRINCIPLES OF OSTEOPATHY. 289 

Dorsal Rotation. — Fig. 117 is a simple method of se- 
curing flexibility in the lower dorsal portion of the back. Ro- 
tation is possible in the dorsal but not in the lumbar region, 
hence, by holding the shoulders down and lifting one hip, rota- 
tion is secured in the dorsal region. This movement forces the 
normal action between individual vertebrae of the lower dor- 
sal region. If any particular articulation is at fault, it will 
not yield to such a general movement as this. The only gain 
made by it in that case is to prepare the surrounding tissues 
for more specific work. 

Lateral Curvature. — This kind of deformity is fre- 
quently found and a large proportion of such cases are bene- 
fited by osteopathic manipulation. These curves are developed 
as a result of improper sitting. A weakened condition of the 
whole body predisposes to the formation of a lateral curve. 
Fig. 118 illustrates an uncompensated lateral curve, that is, 
the curvature is all in one direction. In such a case the 
muscles on the convex side are not doing their full duty. The 
patient is allowing the weight of the upper portion of the 
trunk to be held by the ligaments instead of the muscles. This 
simple curvature can be readily overcome by exercises which 
will develop the weak spinal muscles. 

Fig. 119 illustrates a compensated curve, that is, a letter 
S curve. The primary curve is in the interscapular region 
and is compensated for by a curve in the opposite direction in 
the lumbar region. This case is much more deep-seated than 
the previous one. This child was plump, but very weak. 
There were some symptoms of inflammation of the fifth, sixth 
and seventh vertebrae. This case requires manipulation which 
will twist the vertebrae in a direction opposite to their present 
tendency. The manipulation must be centered on the affected 
vertebrae. Extension of the spine will also be beneficial. 
Voluntary exercises should be taken gradually to strengthen 
the muscles. 

Know How to Apply Principles. — The osteopath 
should know how to apply his principles so thoroughly that 
the position of his patient, whether lying, sitting or standing, 
will not confuse him. Some osteopaths desire to give their 



290 



PRINCIPLES OF OSTEOPATHY. 



manipulations to the patient sitting, others like the reclining 
position better. On the whole, it seems best to select the po- 
sition suited to the special work required. 

Do Not Copy Movements. — Do not copy anybody's 
movements. Learn the principles, then apply them in the 




Fig. 119. — A case of compensated lateral curvature. 



manner most satisfactory to yourself and helpful to the pa- 
tient. To understand the principles and apply them intelli- 
gently, one cannot know too much concerning all the subjects 
which are the basis of a broad medical education. I do not 
mean by this that the student is to waste any time on drugs. 
From the osteopathic standpoint, drugs are not a part of the 
basis of a medical education. 



PRINCIPLES OF OSTEOPATHY. 291 



CHAPTER XV. 



REDUCTION OF SUBLUXATIONS. 

Having noted a few movements which have a general ben- 
eficial effect on groups of structures, we will now examine a 
few of the movements which are applicable to specific subluxa- 
tions. 

In the chapter on Subluxation in the theoretical section of 
this volume, we called attention to the fact that "A subluxation 
is a slight abnormal relation between bony surfaces, maintained 
by uneven contraction in opposing groups of muscles which 
control the articulation. The causes of the contraction are 
violence, temperature changes, and reflex irritation. A reduc- 
tion is secured by equalizing vital activity." With this state- 
ment in rnind, we will study first the lateral subluxations in the 
dorsal region. 

Lateral Subluxation. — A lateral subluxation is possi- 
ble only in those portions of the spinal column where the for- 
mation of the articular facets allow rotation. The cervical and 
dorsal are the regions in which this occurs. Lateral sub- 
luxation is most common in the articulations of the atlas, third 
cervical, and anywhere in the dorsal with the exception of the 
twelfth. The inferior articular facets of the twelfth are lumbar 
in character, hence allow only flexion, extension and circum- 
duction. 

It makes no difference what the cause of the lateral sub- 
luxation may be, the uneven contraction of muscles is the final 
result, hence all are treated in the same manner. 

When the vertebral spine is discovered out of line with 
those above and below and tenderness noted on its prominent 
side, we are disposed to consider it a true lesion, an irritant to 
the nervous system. Whether it is the result of accident, cold 
or reflexes does not need to be seriously considered. While 
it exists, it is a continual source of irritation to the nervous sys- 
tem, hence should be removed without delay. If it is the re- 
sult of reflexes, its reduction will at least remove one disturb- 
ing factor from the case. 



292 



PRINCIPLES OF OSTEOPATHY. 



The prominent side of the spine is the one on which the 
muscles are contracted. The contracted muscles must be 
those which are holding the bone in its mal-position. In order 
to exert this influence, they must be attached in such a way as 
to move the bone in this direction when they act normally. 




120. — Surface indication of a lateral subluxation. 



Their present condition is one of hyperactivity. With this 
line of reasoning, any articulation can be examined, the pull 
of its muscles determined and movements made in accordance 
with the normal action of these muscles. 

In Fig. 120 we observe the subluxation to the left of a 
mid-dorsal vertebra. Intrinsic rotation of the dorsal spines is 



PRINCIPLES OF OSTEOPATHY. 



293 



the result of the contraction of the rotatores spinae, one of 
the fifth group. In order for this vertebra to remain sublux- 
ated, i. e., more rotated than any of its fellows, the particular 
digitation of the rotatores spinae attached to it must remain 
contracted after the other dictations have become relaxed. 




Fig. 121 — •' Exaggeration" of a lateral subluxation. 

The work laid out for us is relaxation of this one digitation. 
The digitation which is acting is working from below, i. e., 
arises from the transverse process of the vertebra below the 
one which is subluxated. 

The first movement consists in "exaggerating the lesion." 
The patient's body is flexed laterally away from the promi- 
nent side of the lesion as in Fig. 121. This procedure stretches 



294 



PRINCIPLES OF OSTEOPATHY. 



the contracted rotatores spinae and also separates the three 
vertebrae, i. e., the subluxated one and the superior and in- 
ferior ones, thus making it easier to push the subluxated ver- 
tebra into its true position. 

i 




lateral subluxation. 



The second movement is an anterior flexion to permit 
of greater freedom of movement between the articular pro- 
cesses. By forcing the body first into the position of lateral 
flexion, then anterior flexion, all the muscles of the fifth 
group which affect the subluxated vertebra are relaxed. Dur- 
ing this anterior flexion, a "click" is sometimes heard which 
is evidence of relaxation sufficient to allow approximation of 



PRINCIPLES OF OSTEOPATHY. 



295 



the subluxated surfaces. During all the time of making these 
flexions, the physician's right thumb should make steady 
pressure against the prominent side of the spine, thus taking 
advantage of the relaxation gained by each flexion. The an- 
terior flexion is illustrated in Figf. 122. 




Fig. 123. — Extension and counter pressure-lateral subluxation. 



The final movement is lateral flexion toward the lesion 
while lifting the patient from the stool in such a way that the 
weight of the body below the lesion exerts its influence to 
separate the vertebrae. Fig. 123. Counter pressure with the 
thumb is made vigorously during this final movement. 



296 



PRINCIPLES OF OSTEOPATHY. 



The successful reduction of this subluxation may be ac- 
complished without any "click" or other evidence of movement 
of the surfaces. The vertebra usually moves into its true po- 
sition without any audible sign. The physician's fingers can 
determine the success or failure of the movement. If the sub- 
luxation were caused by accident or cold, its reduction is all 







* 




Fig. 124. — Leverage applied to a lateral subluxation in the mid-dorsal region. 



that is needed, but if it is the result of reflex irritation orig- 
inating in a viscus, the physician must direct such a mode of 
living that rest may be secured for the stimulated viscus. Hab- 
its of life must be looked into. 

Fig. 124 illustrates another method of reducing a slight 
lateral subluxation. The physician's left arm passes under 



PRINCIPLES OF OSTEOPATHY. 297 

the patient's left axillary, then the hand is placed firmly on 
the base of the neck posteriorly. This gives the physician 
great leverage. The physician's knee, right or left, is placed 
against the spinal column at a point four or five inches below 
the subluxation. This compels the flexible spinal column to 
yield to the force applied at the neck, in such a way as to relax 
the deep muscles controlling the subluxation. Counter pres- 
sure applied to the prominent spine by the physician's right 
thumb completes the movement. By this movement about the 
same result is obtained as when counter extension is given by 
two men pulling at the head and feet of the patient, while a 
third one devotes his attention to forcing the vertebral spine 
into place. When the patient is short and heavily muscled, 
it is impossible to execute this movement satisfactorily. 

Lateral Subluxation — Lower Dorsal. — A lateral lesion 
of the ninth, tenth or eleventh dorsal is more easily handled 
than those higher up, because the physician can grasp the 
patient in a much more satisfactory manner. Fig. 125 illus- 
trates the method. 

The series of movements are always the same as already 
described, that is, lateral flexion or "exaggeration," anterior 
flexion, then lateral flexion toward the lesion as illustrated by 
the cut. 

With this same position, other forms of subluxation in 
the lower dorsal and lumbar regions can be corrected. 

A Depressed Spine. — Slight depression of a dorsal 
spine with sensitiveness over it, that is, between its apex and 
the spine below, indicates that the muscles in that situation are 
sufficiently contracted to draw the spine of the upper vertebra 
downward. The depressed spine indicates that the body of the 
vertebra is slightly tipped backward and downward. See chap- 
ter on Subluxations. 

To reduce this lesion, a flexion of the spinal column as 
far as the vertebra below is made anteriorly. If the depressed 
spine is any one of the upper six dorsal, use the pull of the 
splenitis capitis et colli, i. e., flex the head and neck as in Fig. 
11. The physician's right hand is placed on the spine of the 
vertebra below the subluxation, thus allowing all the force 



29& 



PRINCIPLES OF OSTEOPATHY. 




Fig. 125. — Leverage applied to a lateral subluxation in the lower dorsal region. 

of the movement to terminate in a pull on the muscles be- 
tween this vertebra and the depressed spine. This same prin- 
ciple can be applied to all portions of the spinal column. 

When individual spines are prominent, and sensitiveness 
is found above the process instead of below, we have a condi- 
tion the reverse of that just described. Its treatment is sim- 



PRINCIPLES OF OSTEOPATHY. 299 

ilar to that of the preceding, except that by changing the po- 
sition of the right hand to rest upon the prominent spine, our 
leverage affects the contracted muscles above the spine. 

Kyphosis — Pott's Disease. — Whenever a "knuckle" is 
found in the spine, inquire carefully as to the possibility of 
direct injury, predisposition to tuberculosis, etc. Pott's dis- 
ease of the spinal column causes prominence of a single ver- 
tebral spine. As other vertebrae are affected, a kyphosis is 
developed. 

According to the principles written by Dr. Hilton, in his 
volume on "Rest and Pain," there should be perfect rest in a 
case of spinal caries. His idea of a cure is ankylosis. The 
osteopathic principle is directly opposed to the idea of rest. 
As has been stated before in these pages, flexibility is the key- 
note of health, because a perfect circulation can exist only 
where free movement is maintained. 

The predisposing cause of Pott's disease is a strain or 
bruise of a vertebral articulation which results in the hyper- 
aemia of repair. Muscular contraction occurs as a reflex ef- 
fort of nature to hold the parts quiet. This muscular con- 
traction finally becomes a menace to the life of the parts which 
are being held by it, that is, it obstructs the free drainage of 
the injured part. Further destruction of tissue is favored by 
the lack of drainage occasioned by the loss of mobility. 

There are many people with rigid, deformed joints who 
are living examples of the fixation theory as applied in sur- 
gical practice. Ten years is scarcely time enough in which 
to show a sufficient number of cases successfully handled ac- 
cording to osteopathic principles. Nevertheless, quite an ar- 
ray of cases can be referred to as evidence of successful appli- 
cation of principles of mobility. 

The osteopathic work done on cases of spinal caries has 
demonstrated that when passive movement of the involved re- 
gion is made, so as to free the venous circulation, the work 
of repair is immediately started. Time is the essence of the 
contract in such cases. 

The author has seen cases of spinal caries in patients 
ranging from five to sixty years of age. The oldest was 



3oo PRINCIPLES OF OSTEOPATHY. 

treated with as much success as the youngest. When one has 
seen a patient sixty years of age suffering from spinal caries 
to the extent that standing or sitting without support of a 
plaster jacket was impossible, and the slightest weight of the 
body would cause the vertebrae to press the nerves of the 
lumbar plexus to such an extent that the pain became instantly 
unendurable ; then to see this patient, after four years' of os- 
teopathic treatment, able to ride a bicycle and the plaster cast 
thrown aside, one cannot be blamed for expressing enthusi- 
asm. 

I have examined but one child in the early stages of Pott's 
disease. It seems that little attention is paid to the actions of 
young children until the back becomes so weak and deformed 
that the child rests his hands on his thighs for support. In- 
variably a brace or plaster jacket, usually the latter, is applied 
to the child by the family doctor. 

As to whether or not a brace should be applied is an open 
question to the osteopath. If all cases could be put under the 
care of an osteopath before the caries had involved more than 
one or two vertebrae, slightly, it is my opinion that a brace is 
useless. The passive movements will have a sufficient effect 
to start the process of repair in spite of the compression of 
the vertebrae by the weight of the body. In cases showing 
a kyphosis, involving several vertebrae, and where the patient 
cannot stand erect, but sustains the weight by the help of the 
hands on the thighs, we always apply a brace ; a steel brace, 
not a plaster or sole leather jacket. This sustains the patient 
when exercising. The osteopathic treatment is a direct ef- 
fort to secure flexibility in each vertebral articulation. 

Examination should determine whether a collection of pus 
exists along the anterior surface of the vertebrae. If the 
kyphosis is in the lower dorsal or lumbar regions, examine 
carefully through the abdominal walls for the outline of a 
collection of pus in the sheaths of the psoas muscles. Note 
the length of the legs, condition of the hip joint, temperature 
of the spine, whether fluctuation can be shown under the 
origin of the rectus femoris. If much pus exists, the exam- 
ination of these joints should show it. 



PRINCIPLES OF OSTEOPATHY. 301 

If a pus sack is found, do not treat the case by using such 
heavy movements as might rupture the sack. In any case of 
Pott's disease, we do not attempt immediately to reduce the 
deformity; that is not the object of the treatment, and should 
not be expected. The object should be to stop the disease 
process and have it leave the tissues in such condition that the 
patient can move them. It is too much to expect the restora- 
tion of the destroyed bone to its original form. 

I was called to examine a case of Pott's disease which had 
been treated osteopathically for six months previously. The 
patient showed marked signs of improvement during the first 
month. His sole desire had been to get rid of the deformity, 
hence he urged his physician to force the vertebrae to their 
normal position. With the help of an assistant this was par- 
tially done, much to the satisfaction of the patient. He stood 
straighter and walked better. This gain was only temporary, 
because the severity of the treatment started the pus to col- 
lecting in the sheath of the psoas muscle, and at the time of my 
examination had gravitated to a position around the hip joint. 
It had worked its way from the lesser trochanter to a position 
behind the greater trachanter. Fluctuation was present. I 
refused to treat the case. There was a fatal termination within 
a few months. 

I always refuse cases in which a pus sack is clearly defined. 
Such cases are beyond control by manipulation. There may 
be osteopaths who are willing to handle such cases. I have 
not seen any successfully handled after the stage has been 
reached which has just been described. 

Counter extension of the spine should be practiced by the 
patient's relatives at least every night and morning. Children 
should be compelled to rest at least twice a day, morning and 
afternoon. If a brace is deemed advisable, be sure it fits the 
patient well. Have it removed during the rest periods and at 
night. See that it does not cause abrasions of the skin. 

I have noted here the good and bad effects of the applica- 
tion of osteopathic principles to this disease, so that the stu- 
dent may realize that each case must be examined with ex- 
treme care before anv movements are made. 



3 02 



PRINCIPLES OF OSTEOPATHY. 




Fig. 126.- — A method of. spreading the lower ribs and stretching the diaphragm. 



When adhesions are forming between the vertebrae as a 
result of the inflammation, the use of such movements as will 
force the normal movement of the joint are indicated. After 
a treatment is given which breaks up one of these adhesions, 
it is best to let the patient rest at least one week. Too frequent 
treatments keep up a continual irritation. If the patient is 



PRINCIPLES OF OSTEOPATHY. 303 

not wearing a brace at all, or only a portion of the time, enough 
voluntary movement will be made to prevent the re- formation 
of the adhesion. 

If a brace is being worn most or all of the time, treatments 
should be given at least three times a week in order to keep 
up the relaxation. 

The movements outlined heretofore for the treatment of 
general spinal conditions, especially kyphosis, are applicable 
in the treatment of Pott's disease. 

Rib Subluxations. — Rib subluxations present many 
difficulties to the osteopath. The methods used in their re- 
duction are as varied as can well be imagined. A few of the 
most useful and direct are given here. 

In Fig. 126 the physician is applying a method of spread- 
ing the lower ribs. When the tenth rib sinks under the ninth 
and there is a general jamming of the four lower ribs together, 
the physician stands behind the patient who raises his hands 
above his head to spread the lower ribs by means of the latis- 
simus dorsi. While the hands are elevated, the physician grasps 
the anterior extremities of the ribs and holds them up while 
the patient lowers his hands to his thighs. Such a movement 
as this will replace the ribs in their right relations, but a flex- 
ion of the patient's body will undo the work. Continual well 
directed treatment and voluntary exercise are needed to bring 
them to place and hold them there. 

The four lower ribs can be separated and the anteroposte- 
rior diameter of the thorax increased by the method illustrated 
in Fig. 127. 

The left hand lifts on the angles of the depressed ribs 
while the patient's arm is extended beyond his head, thus mak- 
ing use of the leverage gained through the attachment of the 
latisimus dorsi. This movement increases the right and left 
hypochondriacal spaces. 

The position of an individual rib is affected by the con- 
traction of the intercostal muscles above and below it. The 
spacing determines whether the rib is elevated or depressed. 
The width of an intercostal space will not be the same be- 
tween the angles and anterior extremities. This is caused by 



3Q4 



PRINCIPLES OF OSTEOPATHY. 



the fact that the head of the rib is fixed so that it cannot move 
up or down. The movement which takes place between the 
head of the rib and the vertebra is a slight rotation. The 
costo-transverse articulation allows a slight gliding of the ar- 
ticular facet of the rib upon that of the transverse processes. 
As an example, take the fifth rib, when the space between it 
and the fourth rib is lessened bv the contraction of the fourth 




Fig. 127. — Spreading the lower ribs by using the latissimus dorsi. 



intercostals. The lower margin of the rib becomes prominent 
because the rib is twisted when raised. The anterior extrem- 
ity is depressed, making the fourth intercostal space wider 
anteriorly. Palpation of this rib in this condition will show 
a prominent angle with corresponding depression of the an- 
terior extremity. When the rib is depressed at the angle, its 
anterior extremity will be prominent. 

Palpation is the only method of discovering these sub- 



PRINCIPLES OP OSTEOPATHY. 



305 




Fig. 128. — First position to reduce a subluxated fifth rib. 



luxations. To reduce them, the same principle we applied to 
reduction of vertebral subluxations must be applied here, i. e., 
the relaxation of the contracted muscles. 



3°6 



PRINCIPLES OF OSTEOPATHY. 




Fig. 



-Second oosition to reduce 



subluxated fifth rib. 



The tendency in asthmatic and bronchitic patients is to 
cause elevation of the ribs, thus developing a barrel-shaped 
chest. When all the intercostal muscles act equally, the ribs 
are equally spaced, but in a case of bronchitis, some local por- 



PRINCIPLES OF OSTEOPATHY. 307 

tion of the bronchial tubing is especially irritated. From this 
area, irritant impulses reach the spinal center with which it 
is most closely associated. The intercostal muscles in direct 
relation with this center receive a greater number of impulses, 
hence, contract more vigorously. A strain or blow might cause 
the same result. 

To bring this fifth rib down to its proper position, the 
physician may stand behind his patient as is illustrated by Fig. 
128. His left hand grasps the patient's right elbow and pushes 
it above the shoulder, thus causing the muscles to lift the ribs. 
This movement will pull on all the ribs of the right side, and 
tend to equalize the spacing. The physician places his left 
knee directly over the angle of the fifth rib, his right hand on 
the anterior extremities of the fifth, sixth and seventh ribs, 
the middle finger of this hand being applied against the lower 
margin of the fifth rib. The rib being now in right relation 
with its fellows, the critical period of the movement is when 
relaxation is allowed by lowering the arm. The knee above 
and over the angle, pressing forward and downward, while the 
middle finger of the right hand prevents depression of the 
anterior extremity. This leverage forces the rib to retain right 
relations with its fellow in relaxation of the chest. The ter- 
mination of the movement is illustrated by Fig. 129. 

A general depression of all the angles of the ribs causes 
their superior margins to be prominent. A flat chest is the 
result. This condition frequently follows pneumonia or some 
disease which causes the patient to lie on the back during a 
long period of weakness. 

When a single depressed rib is found, it usually has been 
caused by a strain which has weakened the intercostal muscles 
in the space above it. Treat it while standing in front of the 
patient. Place the middle finger of the left hand under the 
angle. The patient's right elbow may rest against the phy- 
sician's abdomen. Pressure made on the elbow forces the 
scapula back and brings into action the serratus magnus which 
lifts the ribs. Ask the patient to inspire and this will raise 
all the ribs. When relaxation comes with expiration, lift the 
angle of the rib forcefully, and it will regain its proper posi- 



3 o8 



PRINCIPLES OF OSTEOPATHY. 







Fig. 130. — The position of the fingers below the angle of a depressed rib. 



tion. Fig. 130 illustrates this movement. Some osteopaths 
grasp the patient's right wrist and extend the arm first for- 
ward, then above the head, and back to the side, instead of 
placing the patient's elbow against the abdomen. 

It will be noted that all these movements are based on the 
effects of muscular contraction and relaxation with resulting 



PRINCIPLES OF OSTEOPATHY. 



309 



changes of the position of the structures to which they are at- 
tached. 

Figs. 131, 132 and 133 illustrate *the method of raising 
and spreading the lower ribs. With the patient in this posi- 
tion, the physician can make extensive passive movements 




Fig. 131. — The first position in lifting a series of depressed lower ribs. 



without much resistance. These movements are similar to that 
illustrated by Fig. 126. 

When the ribs '"droop" to a marked degree, there is a 
decided change in the shape of the diaphragm. The extent 
of the thoracic floor is lessened, and it may be that the struct- 
ures passing through the diaphragm are detrimentally af- 



3io 



PRINCIPLES OF OSTEOPATHY. 




Fig. 132. — The second position in lifting a series of depressed lower ribs. 



fected by it. The movement pictured in Fig. 126 is well cal- 
culated to spread the lower ribs and thereby increase respira- 
tory capacity. 

The first rib is so strongly held by the scalenus anticus 
that it practically never is depressed. It is, however, fre- 
quently elevated to such an extent that it infringes on struct- 



PRINCIPLES OF OSTEOPATHY. 



3ii 




Fig. J 33- — The third position in lifting a series of depressed lower ribs. 



ures around the first thoracic sympathetic ganglion, thus affect- 
ing heart action. 

To depress the first rib to its proper position, it is nec- 
essary to take the extra contraction out of the scalenus anticus. 
This is done by making the first rib a fixed instead of a mov- 
able attachment. Fig. 140 illustrates the method of relaxing 
the scalenus anticus. The physician's thumb holds the first 



312 



PRINCIPLES OF OSTEOPATHY. 



rib down while the muscle is stretched by forcing the patient's 
head directly to the opposite side. The scaleni muscles can 
be easily detected by placing one's fingers on the side of the 
neck near the base. They will be felt hardening during in- 
spiration. 

Luxations of the Innominate Bones. — Examination of 
the innominate bones requires very close observation of all the 
factors concerned in tilting the pelvis and varying the length 
of the lower extremities. 




M 



Fig. 134. — Position for treatment of an upward and forward dislocation 
of the ilium. 



We have noted the immobility of the sacro-iliac articula- 
tions, in a previous chapter. Unless a decided accident has 
been experienced by the patient, it is hardly conceivable that 
the innominates and sacrum could have their relations dis- 
turbed. 

All the cases of luxation of the innominate which Ave have 
examined in clinic and private practice presented a very vivid 
history of severe accident. The symptoms were principally 
those of pain, muscular tension and joint stiffness in the ex- 



PRINCIPLES OF OSTEOPATHY. 



3i3 



tremity on the affected side. Two cases of luxated innomi- 
nate in females gave no signs of disturbed pelvic viscera, al- 
though we would expect decided disturbance in that region. 
The only way to determine the condition of the innomi- 
nates is by palpation and mensuration. Have the patient 
stripped and sitting in a perfectly upright position on a level 
surface. Determine the condition of the lumbar portion of 
the spinal column. Have the patient's shoulders level. While 
the patient is in this position the relative prominence of the 




Fig- 1 35- — A dangerous method of applying force to the sacro-iliac articulation. 

posterior superior iliac spines can be noted by palpation. Find 
the second sacral spine and note the relations of the iliac 
spines to it. They should all be on a level. See Fig. 54 in 
chapter VIII. Palpate for sensitiveness around the iliac 
spines, crests of the ilia and crests of pubes. Measure from 
the anterior superior iliac spines to the adductor tubercles on 
the internal condyles of the femur, when the patient rests 
evenly in the dorsal position. . This measurement is not en- 
tirely satisfactory, because any change in the thigh muscles 
or hip rotators may easily vary the measurements. The only 



3H 



PRINCIPLES OF OSTEOPATHY. 



fixed structures from which a reckoning can be made are the 
second sacral and posterior superior iliac spines. The rela- 
tions between the sacrum and ilium are never greatly changed, 
therefore it requires the examiner to exclude practically all 
measurements which might be varied by muscular tension. 




Fig. 136. — First position to raise the clavicle. 



The posterior superior iliac spine may be less prominent 
than its fellow on the opposite side, or vice versa. There may 
not be enough upward or downward displacement to make a 
well recognized change in horizontal relations with the second 
sacral spine. This being the case, it is decidedly difficult to 
determine which side is normal and which is abnormal. Hy- 
per aesthesia will have to be depended on to determine this 



PRINCIPLES OF OSTEOPATHY. 



3i5 



point. The related subjective symptoms of the patient will 
decide which is the affected side. 

The shock which is transmitted to this articulation in 
an accident usually strikes the tuber ischii from below, or pos- 
teriorly, or strikes the knee and the force is exerted against 
the ascetabulum. When the force is asrainst the tuber ischii 




Fig. 137. — Second position to raise the clavicle. 



from below, or posteriorly, we have an upward displacement, 
or a twist, causing the posterior superior iliac spine to become 
more prominent. When the force strikes the ascetabulum by 
means of the femur, the twist is in the opposite direction, and 
the spine is less prominent. 

Have the patient give details, if possible, concerning his 



3i6 



PRINCIPLES OF OSTEOPATHY. 



position with reference to the direction of the force at the time 
of the accident. 

Having determined the direction of the twist, the force 
of our manipulation must be made counter to that applied at 
the time of the accident. Since the hip joint is very movable, 
we cannot use the thigh as a stiff lever, therefore, our force 
must be applied to either the anterior or posterior surface of 




Fig. 138. — Relaxation of the cervical fibers of the trapezius. 



the tuber ischii and to the anterior or posterior superior spine 
of the ilium, i. e., push and pull, such as turning a wheel on 
its axle. This movement is illustrated in Fig. 134. The orig- 
inal force which this movement is trying to overcome, was 
transmitted from the knee by the femur to the acetabulum, and 
resulted in a twist of the ilum which made the posterior su- 
perior spine less prominent than its fellow of the opposite 
side. In order to make this movement effectual, an assistant 



PRINCIPLES OF OSTEOPATHY. 



3i7 



must make steady, even pressure over the articulation of the 
sacrum and fifth lumbar vertebra, i. e., overcome the tendency 
of the twisting movement to merely affect the movable sacro- 
vertebral, instead of the immovable sacro-iliac articulation. 

By flexing the patient's thigh on to his abdomen, sufficient 
opportunity is given the physician to make pressure on the an- 
terior surface of the tuber ischii, and pull forward on the pos- 




Fig. 139- — Relaxation of the sterno-cleido-mastoid. 



terior superior iliac spine, thus reversing the movement illus- 
trated by Fig. 134. 

Fig. 135 illustrates an effort to use the thigh as a lever 
to effect the sacro-iliac articulation when the posterior superior 
spine is prominent. This is a dangerous movement, and should 
not be used. The force transmitted by the thigh as a lever 
will not reach the joint desired, and will only result in straining 
the ilio-femoral ligament. 



PRINCIPLES OF OSTEOPATHY. 



CHAPTER XVI. 



TREATMENT OF THE CERVICAL REGION. 

The treatment of the clavicles must be considered here, 
because their position so frequently interferes with the drain- 
age of the tissues of the neck. When it is held down too close 
to the first rib by shortening of the subclavius muscle, it is 






F'g. 140. — Relaxation of the scaleni by depressing the first rib. 



quite sure to affect venous circulation in the head and neck. 
To raise the Clavicle. — To raise it place the right 
thumb on the first rib as is illustrated by Fig. 136, then carry 
the patient's left forearm across his face above the head as in 
Fig. 137. Then as far outward as the physician's arm. This 



PRINCIPLES OF OSTEOPATHY. 



3i9 



movement causes the clavicle to press down on the physician's 
thumb, where it rests on the first rib, and thus stretches the 
subclavius. 

Subluxation of the Clavicle. — Articulations, such as 
the sterno-clavicular and acromio-clavicular, which depend en- 
tirely on their ligaments to keep them together and to limit 
their motion, cannot be retained in place if their ligaments 




Fig. 141. — Relaxation of the splenius capitis et colli. 



have been injured. If the ligaments of the sterno-clavicular 
joint becomes relaxed, the pull of the sterno-cleido-mastoid 
lifts it upward. Slight irritation of the pneumogastric nerve 
may be occasioned by this change of position. 

Preparatory Treatment of the Neck — Trapezius. — The 
preparatory treatment of the neck consists in movements to 



320 



PRINCIPLES OF OSTEOPATHY. 



relax the various groups of muscles. Fig. 138 illustrates the 
method of relaxing the cervical portion of the trapezius. One 
hand on the shoulder holds it firmly down, while the other, 
hand forces the head as far as possible in the opposite direc- 
tion. Relax the opposite muscle in a similar manner. 

Sterno-cleido-mastoid. — Next, relax the sterno-cleido- 
mastoid by separating its attachments as far as possible, as in 
Fig. 139, also by direct manipulation. Observe whether both 




Fig. 142. — Extension of the neck. 



muscles will relax equally. These large muscles are fre- 
quently found unevenly contracted. Since the spinal acces- 
sory nerves control these muscles, any contraction should lead 
the physician to examine all parts in connection with them. A 
reflex from the laryngeal branches as well as pneumogastric 
branches might account for it. 

Scaleni. — The scaleni muscles should be treated as al- 
ready mentioned in Chap. XV. See Fig. 140. 



PRINCIPLES OF OSTEOPATHY. 



321 



Splenius Capitis et Colli. — Fig. 141 illustrates a meth- 
od of stretching the ligamentum nuchae as well as all the ex- 
tensor muscles on the back of the neck. This may be modi- 
fied by forcing the chin backward with one hand, while they 
other flexes the head as sharply as possible. This stretches 
the muscles and ligaments on the posterior portion of the 
occipital-atlantal and axial articulations. The retraction of the 
chin governs the amount of stretching exerted by the flexion. 




Fig. 143. — Position for circumduction of the neck to relax the muscles of 

the fifth layer. 



Extension. — Direct extension of the neck makes an 
equal pull on all the vertebrae. When the patient's feet are 
anchored, the force of the pull is felt in the weakest portions 
of the spinal column. The average patient requiring . this 
treatment enjoys a delicious stimulation after relaxation of 
the extension. A few who are extremely nervous may give a 
bad reaction. The influx of blood in the spinal cord is highly 
16 beneficial to those who have sufficient vaso-motor tone to hold 



322 



PRINCIPLES OF OSTEOPATHY. 



it there, but those who lack this tone will feel faint or even 
absolutely lose consciousness. Simply allowing them to rest 
on the table until the vascular system reacts, will enable them 
to reap the full benefit of the treatment. The extension should 
be made with absolute steadiness. The relaxation period is 
usually the one in which any vaso-motor phenomena are noted. 
The tension should be lessened very slowly in all cases. Fig. 
142 shows the position of the physician's hands. 




Fig. 144. — Relaxation of the stylo-hyoid and posterior belly of the digastric. 



Rotation. — The following movement is one for which long 
practice is required in order to get anything like a successful 
result from its use. It consists in grasping the patient's neck 
with the left hand as in Fig. 143. The patient's head rests 
against and slightly to the right of the physician's forearm. 



PRINCIPLES OF OSTEOPATHY. 



323 



The right hand grasps the chin while the forearm rests firmly 
against the patient's head. The object is to hold the neck and 
head rigid above the point grasped by the thumb and fingers 
of the left hand. While holding the head and neck rigid, they 
are moved so as to force circumduction in the joint below the 




Fig. 145.- — Relaxation of the mylo-hyoid and hyo-glossus. 



grasp of the left hand. After each circumduction the left hand 
is shifted the depth of one vertebra nearer the head. Thus all 
the intervertebral articulations in the cervical region are re- 
laxed and specific work on a definite articulation can be done 
more easily. 

The Hyoid Bone. — Work on the anterior portion of 
the neck consists in affecting the condition of groups of mus- 



324 



PRINCIPLES OF OSTEOPATHY. 



cles forming the floor of the mouth and extrinsic muscles of the 
larynx. 

The Hyoid bone is the movable part which can be grasped 
by the physician's fingers. Drawing it downward and to the 
right, as in Fig. 144 relaxes the stylohyoid and posterior belly 
of the digastric. A contractured condition of these muscies 
may affect the pneumogastric nerve. 




Fig. 146. — Relaxation of the crico-thyroid. 



Mylo-hyoid and Hyoglossus. — The mylo-hyoid and 
hyoglossus forming the floor of the mouth may be treated as 
in Fig. 145 . When the maxillary glands are congested, it is 
necessary to relax these muscles. The physician's right hand 
grasps the hyoid bone, being careful to provide enough loose 
skin above the bone so that the force will not be exerted on 
the cutaneous tissues instead of the muscles underneath. After 



PRINCIPLES OF OSTEOPATHY. 



325 



the hyoid bone is pulled downward, the tension of the mylo- 
hyoid is increased by using the pressure of the fingers of the 
left hand. 




Fig. 



147. — Reduction of subluxation of the atlas — right transverse process too 
far posterior — exaggeration. 



Sterno-thyroid and Sterno-hyoid. — The depressor mus- 
cles of the larynx and hyoid may be stretched by forcing these 
structures toward the angle of the jaw, while the free hand 
makes direct manipulation of the muscles. In all cases of con- 
gestion of the glands, mucous membranes or cellular tissues 



326 



PRINCIPLES OF OSTEOPATHY. 




Fig. 148. — Reduction of subluxation of the atlas — lateral flexion. 



of the mouth, pharynx or larynx, these muscles should be re- 
laxed if the position of the atlas has been corrected. 

Intrinsic Muscles of the Larnyx. — The intrinsic mus- 
cles of the larvnx sometimes need attention. The crico- thyroid 



PRINCIPLES OF OSTEOPATHY. 



327 



is the tuning muscle of the larynx. This may be demonstrated 
by grasping the thyroid cartilage with the thumb and fore- 




Fig. 149. — Reduction of subluxation of the atlas — extension and counter pressure. 

finger of one hand, while the thumb and forefinger of the other 
riand grasps lightly the cricoid cartilage, as in Fig. 146. If 
the cartilages are slightly separated while the patient makes a 



328 



PRINCIPLES OF OSTEOPATHY. 



vowel sound, the pitch of the voice will be perceptibly lowered. 
This is occasioned by relaxation of the vocal cords by separat- 
ing the cartilages which stretch the crico-thyroid. This mus- 
cle is innervated by the external branch of the superior laryn- 
geal branch of the pneumogastric. The motor fibres of the 
superior laryngeal come from the spinal accessory, hence we 
find lesions in the cervical articulations which are primary 
causes of larvneeal disorders. 




Fig. 150. — Manner of holding the head and neck in order to reduce a subluxated 
sixth cervical vertebra. 



The Atlas. — The atlas, on account of its position, free- 
dom of movement, numerous muscular attachments, etc., is 
subject to frequent subluxation. Fig. 31 in Chapter VIII 
shows the normal relations of the mastoid process, transverse 
process of the atlas, and the angle of the jaw. Fig. 32, in 
Chapter VIII shows the abnormal relations of these various 
prominent points as they are frequently found by the osteo- 
path. When the right transverse process is near the mastoid, 
the left is too close to the angle of the jaw, and vice versa. 

In reducing this twist of the atlas, the physician should 



PRINCIPLES OF OSTEOPATHY. 329 

work on the side which shows the transverse process to be pos- 
terior. The same principle is applied in reducing this subluxa- 
tion as was described in connection with the dorsal lateral sub- 
luxations. Fig. 147 illustrates "exaggeration." Fig. 148 
shows lateral flexion to the left, while the physician's fingers 
make firm pressure back of the prominent transverse process, 
thus steadily taking advantage of all the relaxation gained in 
each portion of the movement. The termination of the move- 
ment is illustrated in Fig. 149. Sometimes the atlas slips into 
place with an audible "click," but more often the physician 
feels a "gritting" sensation as the articular surfaces rub over 
each other. When the subluxation of the atlas is reduced by 
this movement, it will hold its true position more firmly than 
will any other vertebral articulation which has been affected 
in a like manner. This is because the condyles of the occiput 
fit more deeply into the superior articulating surfaces of the 
atlas then is the case between articulating surfaces of pairs of 
vertebrae. 

Sixth Cervical. — The sixth cervical vertebra is espec- 
ially difficult to treat. When the cervical muscles are well 
developed, it is obscured to the touch posteriorly, but the caro- 
tid tubercles anteriorly can be felt. It is not wise to exert much 
pressure upon bony structures from the anterior surface of 
the neck. There are so many glands, nerves, arteries, etc., 
lying over the transverse processes, that direct pressure is liable 
to injure them. 

Fig. 150 illustrates a method of reducing a subluxation of 
the sixth cervical vertebra. The patient's chin rests in the 
physician's hands, which are placed on each side of the neck 
and near enough to the chin to support it by the little finger. 
The thumbs are used to affect the spine directly. The com- 
pression of the head and neck above the lesion by both hands 
keeps them rigid and all are moved together, first to exaggerate 
the lesion of the sixth, then anterior flexion is forced in the 
articulation affected, then lateral flexion with counter pressure 
by the thumb on the prominent side of the spine. 

This movement can be applied to subluxations of the first 
and second dorsal. 



33Q PRINCIPLES OF OSTEOPATHY. 

CHAPTER XVII. 



EXTREMITIES. 

Treatment of the shoulder for synovial adhesions, liga- 
mentous or muscular contractions consists of movements made 
in the normal direction, but carried farther than the patient can 
do so voluntarily. 

Diagnosis. — Test the extent of the movements normal 
to the articulation to ascertain whether the loss of movement 
is general in all directions or results from impairment of some 
special muscle or ligament. 

Causes of Stiff Joints. — The history of the case will us- 
ually give an insight into its cause, progress, etc. The shoul- 
der articulation is frequently stiffened by a sprain, dislocation, 
muscular and articular rheumatism. The simplest cases are 
those resulting from rest, necessitated by a broken clavicle or 
humerus. 

The necessary rest after a dislocation gives the strained 
ligaments an opportunity to shorten and thicken. Movements 
should be frequently forced in such cases to prevent any syno- 
vial adhesions. The differentiation of cases of ankylosis is an 
important one. It is disheartening to physician and patient 
alike to find that after weeks of earnest effort no satisfactory 
results are obtained. 

An article on "Ankylosis" by J. S. White, D. O., of Pasa- 
dena, Cal., published in Vol. V., No. IV., of The Osteopath, 
page 211, deserves quotation here because it notes so clearly the 
important points which the student ought to know. With his 
permission it is quoted in full. 

"Ankylosis. — When, from an injury, disease or other 
cause, a joint loses its function and becomes stiff, it is said to 
be ankylosed. This condition may be termed bony (complete) 
or fibrous (incomplete), true (intra-articular) or false (extra- 
articular) ankylosis. 

"These are the terms used by Da Costa to define ankylosis, 
yet some claim that joint- stiffness caused by extra-articular 



PRINCIPLES OF OSTEOPATHY. 331 

contraction or obstruction is not ankylosis in the correct sense ; 
but on looking at the derivation of the word (an(g)kulos — 
crooked or bent), it seems that the term ankylosis would be 
correct when applied to any form of restricted joint move- 
ment." 

"The causes of ankylosis are many. First, let us con- 
sider those which result in complete and incomplete ankylosis. 
Inflammations in or around the joint from whatever cause, if 
continued long enough for new tissue formation, will cause 
ankylosis. After aseptic inflammations we will most likely 
find fibrous, but when there is infection, bony ankylosis is more 
probable." 

"This fibrous formation is the result of inflammation, for 
wherever there is inflammation there is an increase of tissue. 
Suppose a case of dislocation, with considerable contusion of 
the tissues around the joint, inflammation results, and embry- 
onic tissue begins to form as a reparative process ; the embry- 
onic tissue sends out small processes, which start from new 
centers and spread through the gelatinous mass, in and around 
the joint, until a very irregular network is spread all around 
the joint surface, when the contraction process begins, the new 
tissue is formed into fibrous tissue, which unites the bones 
closely together; by cicatricial contraction the bones may be 
drawn so closely together that movement is almost impossible." 

"Bony union of the joint surface follows fibrous anky- 
losis ; it occurs when the bone itself is injured or diseased, and 
the surface of the bone eroded or broken. Ossification begins 
chiefly in those layers of fibrous tissue lying next to the bone." 

"False or extra-articular ankylosis is caused by the con- 
traction of tissues around the joint. These contractions, exter- 
nal to the joint, may be the result of many remote and obscure 
causes." 

"First. Chronic contraction, which may be due to dis- 
ease or obstruction to the nerve, at the center, or in its course 
to the muscles. As the normal action of muscles is dependent 
on normal nerve stimulus, a muscle may be affected in various 
ways by the stimulus of an over-irritated or inhibited nerve ; 
excess of nerve stimulation will cause a pathological contrac- 



332 PRINCIPLES OF OSTEOPATHY. 

tion, or there may be suspension of nerve stimulus and paraly- 
sis of muscles, allowing the opposing muscles to pull and hold 
the joint in a fixed position." 

"Second. Contractions sufficient to cause permanent fixa- 
tions may follow the healing of wounds, ulcers or abscesses. 
Active contraction, from any cause, if kept in that state any 
length of time can cause the muscle to undergo a state of 
fibroid degeneration ; tissue waste is replaced by fat and fibrous 
material. There is good evidence that, after a time, tissues 
which have not fulfilled their function lose the ability to do so, 
and the nutritive changes accompanying vital activity do not 
take place ; the contiguous fibres and cells become adherent, 
agglutinated, and united by exuded serum and waste material 
not carried away by the circulation, sluggish through inactivity 
of the muscles." 

"The tendons and ligaments around the joint are thickened 
and hardened to the length the limb was held by the active con- 
traction, but after the manner of all newly formed tissue it con- 
tinues to retract and draw the limb more out of its normal 
position." 

"Third. Contractions may be the result of certain dis- 
eases ( as rheumatism, gout, tuberculosis, syphillis or any dis- 
ease causing non-use of the joint or mal-nutrition of the con- 
trolling muscles." 

"In examining an ankylosed joint, we must distinguish 
between bony and fibrous ankylosis and extra-articular contrac- 
tion. A joint may be immovable, and yet not so because of 
bony ankylosis." 

"Da Costa says that a joint immovable from fibrous anky- 
losis is distinguished from a joint immovable from bony anky- 
losis by the fact that in the former, attempts at motion are 
productive of pain and subsequently of inflammation ; there- 
fore, pain on attempted motion excludes bony ankylosis from 
our diagnosis. An approximate idea of the extent of the stiff- 
ness may be obtained from a history of the case as to whether 
the disease has been severe in character and long in duration. 
The nerves of the joint should be examined at their point of 
exit from the spine and throughout their course to the joint." 



PRINCIPLES OF OSTEOPATHY. 333 

"The same conditions, in general, which cause pain in a 
joint may cause ankylosis, whether that pain be due to local 
injury or referred from some other part — a contracted psoas 
muscle by irritation to the branches of the obturator nerve can 
cause pain, contraction and consequent stiffness of the knee 
joint." 

"What can osteopathy do for this condition? For bony 
ankylosis nothing should be attempted, for the treatment would 
only result in discouragement and disappointment to both phy- 
sician and patient; but if the joint is in an almost useless posi- 
tion, excision or osteotomy may be tried with good results. If 
the joint has become ankylosed through septic inflammation, it 
should not be forcibly broken up, because of the danger of 
re-infection of the whole joint or other parts of the body 
through the circulation." 

"In cases of fibrous and extra-articular ankylosis osteo- 
pathy can refer to the most encouraging records, and is un- 
doubtedly ahead of any other method of treatment. The main 
point in the treatment consists principally in making active the 
retarded circulation, gradually breaking up the adhesions, thor- 
oughly relaxing all the muscles, and a stimulating treatment 
to the nerves." 

"For extra-articular ankylosis the treatment is varied ac- 
cording to the cause. Osteopathy has a great mission to fill 
in finding and removing the primary cause of many cases of 
ankylosis. Hilton speaks of a case of diseased (tubercular) 
knee joint cured by ankylosis. True! the rest and ankylosis 
was nature's way of reducing the inflammation and disease 
when it had progressed so far. But the work of the osteopath 
is to look for the causes which made the knee joint "a point of 
least resistance" for the tubercle bacilli to multiply in. Exam- 
ine the spine thoroughly, the sacro-iliac articulation and the 
hip for dislocations, which cause pain in the knee joint through 
irritation of the obturator nerve. But does pain alone in the 
joints lead to the condition known as "a point of least resist- 
ance?" Pain prevents much movement in the joint, and re- 
membering that continued non-use of muscles causes mal- 
nutrition, sluggish circulation, and degeneration of the mus- 



334 PRINCIPLES OF OSTEOPATHY. 

cle, we may see how the joint may become a place for germs 
to multiply." 

"Is it too long a course from simple pain to disease? 
Remember that pain is usually accompanied by contraction of 
muscle. Our treatment must be both preventive and cura- 
tive." 

"Following is a case of fibrous ankylosis and paralysis 
illustrating the efficiency of osteopathy to treat this class of 
sufferers : Vincent Pete, five years of age, had an ankylosed 
elbow as a result of a dislocation and break. The joint was 
attended to immediately after the accident by a regular physi- 
cian, but was kept in the splints too long, which caused the 
fibrous ankylosis. The humerus was broken just above the 
condyles, and a small spicula of bone had protruded so that it 
interfered with those fibres of the median nerve which supply 
the flexor muscles of the thumb and forefinger to such a degree 
that the thumb and forefinger were completely paralyzed as far 
as the flexor movements were concerned. The forearm was 
ankylosed almost at a right angle with the arm, and a very 
little movement could be made, and that with great pain ; the 
muscles in the cervical region of the spine were sore and con- 
tracted. This was the condition of the patient when he came 
for treatment eight weeks after the accident. The improve- 
ment began with the first treatment, and in one month the arm 
was perfectly straight and movable in any direction, and he 
began to have power of movement in his finger and thumb ; 
at the end of two months' treatment his arm had returned to 
almost its usual strength and flexibility. I saw him a month 
later and the arm and hand were perfectly normal. Contrast 
this case with one treated by mechanical rest, resulting in a 
fixed elbow joint, or perhaps a moderately useful joint follow- 
ing forcible breaking of adhesion under anaesthesia, which is 
a dangerous treatment, with very doubtful results, as the oper- 
ation may have to be done over and over again before a useful 
joint is gained." 

The Scapulo-humeral Articulation. — Fig. 151 Illus- 
trates a method of prying the head of the humerus out of the 
glenoid fossa, i. e., separating the articular surfaces. This 



PRINCIPLES OF OSTEOPATHY. 



335 



movement can be used in cases of muscular rheumatism when 
complete abduction of the arm is impossible. It also allows 
an influx of fresh arterial blood. 

When abducting the arm, the scapula must be held b) 
the physician's hands. Place the fingers on the vertebral bor- 
der of the scapula while the axillary border is compressed by 




Fig. 



151. — Manner of applying leverage to stretch the structures forming the 
scapulo-humeral articulation. 



the thumb. By holding the scapula securely, the physician is 
sure that all the movement he forces is in the shoulder articula- 
tion, and not the gliding of the scapula on the thorax. The 
muscles of the arm may be relaxed by direct manipulation. 
The insertion of the deltoid is frequently tender. Any wasting 
of the muscles of the extremity should be carefully noted, so 
that the course of its governing nerve may be searched for a 
point of compression. 



336 PRINCIPLES OF OSTEOPATHY. 

Examination of the Brachial Plexus. — The principal 
motor divisions of the brachial plexus may be tested by simple 
movements made by the patient. The patient's gripping powei 
is an index to the condition of the median nerve, and the mus 
cles it innervates. Extension of the forearm, wrist and fingers 
made against resistance is an index of power in the musculo- 
spiral nerve tract. Abduction and adduction of the fingers are 
controlled by the ulnar nerve. Flexion of the forearm by the 
musculo-cutaneous. 

Observe the condition of the first posterior interosseous 
muscle which forms the little muscular swelling when the 
thumb is adducted to the second metacarpal bone. If it is 
wasted there is evidence of nerve cell degeneration. This mus- 
cle should be well developed in thin hands as well as in fat 
ones. If the wasting is uni-lateral, look for impingement on 
the ulnar nerve at some point in its course. If it is bilateral 
the cells in the spinal cord are probably at fault. 

The deltoid is frequently painful as a result of pressure on 
the circumflex nerve. The pressure is usually at the point of 
exit from the vertebral canal. Relaxation of the structures 
around its point of exit usually relieves. 

Reduction of Dislocations by Traction. — The general 
method applied to dislocations of all joints of the extremities 
is direct traction. This is sometimes aided by pressure on the 
prominent point of the dislocated bone to aid it in slipping to 
its place. All of the dislocations of the humerus, subcoracoid, 
subclavicular, subglenoid and subspinous, can be reduced by 
using traction to stretch the muscles and ligaments of the joint 
to the extent that the head of the humerus will slip over the 
rim of the glenoid fossa. This traction may be made with the 
patient sitting, as in Fig. 142. The knee in the axilla springs 
the head of the humerus outward. The same treatment may 
be applied with the patient reclining. The physician should 
place a ball of woolen yarn in the axilla, then place his stock- 
inged foot upon it, and make traction on the arm. 

It is possible to apply the traction method in a simpler 
way. An ordinary canvas cot, with a hole cut in it, so that 
the arm can be put through while the patient rests easily on his 



PRINCIPLES OF OSTEOPATHY. 



337 




Fig. 152. — A position for easy manipulation of the scapulo-humeral articulation. 



side, should be elevated far enough from the floor to allow a 
six-pound weight to be attached to the wrist. This steady 
weight quickly relaxes the muscles and reduces the subluxa- 
tion. 

Traction always strains the muscles and causes some heat 



338 PRINCIPLES OF OSTEOPATHY. 

and swelling, therefore, care should be taken to prevent exud- 
ates and adhesions. 

Reduction of Dislocations by Leverage. — Those who 
are expert in reducing shoulder dislocations usually make use of 
a series of movements which exaggerate the lesion, i. e., make 
the head of the dislocated bone more prominent. In subcora- 
coid dislocations of the humerus, abduction of the arm causes 
exaggeration. The physician stands at the side of the patient, 
who is reclining on a hard surface. As abduction is made, the 
physician's free hand rests upon the head of the humerus. 
From the position of abduction the arm is carried inward and 
forward on a level with the shoulder, at the same time being 
rotated internally so that the external condyle will be in front 
of the patient's nose, then carry the arm downward to the 
side with a quick, vigorous movement, at the same time exert- 
ing pressure on the head of the bone as before mentioned. 
This series of movements must be made quickly, and the pres- 
sure on the head of the bone be most intense while the internal 
rotation and adduction are at the maximum. 

This series of movements may be employed to break up 
synovial adhesions. 

Elbow Dislocations. — Elbow dislocations are infre- 
quent compared to those of ball and socket joints. The possible 
dislocations of the ulna are lateral and posterior. The former 
require traction, the latter is reduced by placing the bend of 
the patient's elbow over the physician's knee. Traction with 
one hand on the patient's wrist while the other hand makes 
pressure on the olecranon will force the ulna into place. This 
dislocation is usually complicated with fracture of the coronoid 
process. 

The Radius. — The radius may be dislocated posteriorly 
or anteriorly. Lateral dislocations of either radius or ulna 
carry both bones together. A posterior dislocation of the 
radius can be reduced by flexion of the forearm, then extension 
with counter pressure on the prominent point of the head of 
the radius posteriorly. A forward dislocation requires supin- 
ation of the arm and adduction of the hand, together with pres- 
sure on the anterior surface of the head of the radius. 



PRINCIPLES OF OSTEOPATHY. 



339 



Dislocations of the bones of the wrist or hand are reduced 
by traction or pressure. 

Old Dislocations. — All dislocations twenty-four hours 
old require considerable relaxing treatment. The older they 
are, the harder they are to reduce. Nature begins to adapt 
herself to new conditions almost immediately. All the slack 
of muscles and ligaments is swiftly taken up. Those tissues 
most compressed by the new position of the bone are impover- 




Fig. i S3- — Relaxation of the quadriceps extensor. 



ished by the lack of nourishment. Thickenings and adhesions 
quickly form, so that old dislocations are not easily handled. 
Old dislocations are treated in the same manner as fresh ones, 
except that much relaxing and restoring of vitality is neces- 
sary. 

Muscles of the Lower Extremity. — The muscles of the 
lower extremity may be relaxed either by direct manipulation 
or by taking advantage of the movement of various joints to 
put them on a stretch. Direct manipulation is laborious and 
requires considerable time. 



34o 



PRINCIPLES OF OSTEOPATHY. 



The muscles of the hip joint frequently contract sufficiently 
to make walking difficult. They contract as a result of strain, 
bruise, disease of the joint, subluxation of lumbar vertebrae, 
or luxation of the iliac bones. The subluxations irritate the 
nerves which innervate the muscles controlling the joint. 

The movements hereafter outlined may be used for many 
different purposes, but they are applied here to specific groups 
of muscles. All the movements we have thus far outlined have 
been described according to the way they affect structure, not 
function. 




Fig. 



54. — Relaxation of the quadriceps extensor — sacro-vertel 
lowed to remain moveable. 



ral articulation al- 



Quadriceps Extensor. — The quadriceps extensor of 
the thigh is innervated by the anterior crural nerve. In order 
to stretch this muscle the patient should lie face downward. 
The physician grasps the patient's ankle with the left hand 
as in Fig. 153. The right hand holds the pelvis to the table. 
Lifting with the left hand puts the muscle on a tension which 
can be easily increased by flexing the knee. 

This movement stretches the fascia over Poupart's liga- 
ment and the saphenous opening. 



PRINCIPLES OF OSTEOPATHY. 



34 1 



Fig. 154 illustrates a similar movement to the preceeding, 
but it is not so powerful. When the patient lies on the side, his 
back bends to the force of the movement of the leg. If the phy- 
sician grips the ankle instead of the knee there is a great in- 
crease in the effect of the movement. 

The Adductor Group. — The adductor group of thigh 
muscles innervated by the obturator nerve, can be stretched 
as in Fig. 155. If there is any inflammation in the acetabulum, 




Fie. 



-Relaxation of the adductor muscles of the thigh. 



this movement will cause the patient great distress, because it 
stretches the teres ligament. 

Dislocation of the Femur.— Dislocations of the hip 
joint are usually caused by the forcible spreading of the legs. 
The head of the femur is thus forced over the edge of the 
acetabulum at its dependent and weakest part, the cotyloid 
notch. It passes into the thyroid foramen, and if it remains 
there all the muscles are stretched very tight, and no voluntary 
movement is possible. The direction the head takes is depend- 
ent on the direction of the force. If the knee points anteriorly 
at the time of the forced extreme abduction, the head after 



342 



PRINCIPLES OF OSTEOPATHY. 



entering the thyroid foramen passes out of it posteriorly and 
takes a position over the spine of the ischium, great sciatic 
foramen or outer surface of the ilium, all owing to the vigor- 
ous pulling of the muscles. If the knee points posteriorly, 
the head of the femur travels to a position under the anterior 
inferior spine of the ilium. 

The movements made to reduce these subluxations take 
into consideration the fact that the head of the femur must be 
made to retrace its route in order to regain its proper position. 




Fig. 156. — ^Method of stretching the sciatic nerve. 

For example, a dislocation posteriorly on to the spine of the 
ischium causes the toe to turn inward, and there is slight 
shortening of the leg. The physician takes a position as in Fig. 
157 and carries the knee upward and inward. He forces the 
knee as far as possible across the median line, then flexes the 
thigh hard on the abdomen. This turns the head of the femur 
downward and inward. Remember that the head points always 
in the same direction as the internal condyle. Now forcibly 
abduct and extend the thigh with a quick external rotation.. 
These movements cannot be made successfully without a long 



PRINCIPLES OF OSTEOPATHY. 3 43 

course of preliminary relaxing treatments, that is, if the dis- 
location is an old one. 

Direct traction may be used for all dislocations of the 
femur just as for the shoulder, but the muscles are so strong 
that it is no small matter to overcome them, hence movements 
which take advantage of leverage are much more satisfactory. 

The formula for any dislocation of the hip may be worked 
out by noting the position of the head of the femur and then 
carrvingf the internal condyle so as to make the head retrace its 




Fig. 157. — Relaxation of the pyriformis. 

course. When shortening or lengthening of the leg is noted, 
make sure that the iliac bones are even. A half-inch difference 
in them may easily be accounted for by the action of the hip 
muscles. 

The pyriformis muscle may contract and compress the 
sciatic nerve in its course through the great sciatic foramen. 
Fig- 157 illustrates the movement to stretch the pyriformis. 
The physician holds the pelvis to the table by pressing on the 
anterior superior spine of the ilium. The thigh is then strongly 
addncted. 

Stretching the Sciatic Nerve. — Sciatica is frequently 
successfully treated by relaxing the pyriformis, but the major- 



344 



PRINCIPLES OF OSTEOPATHY. 



ity of cases require a stretching of the sciatic nerve, which is 
performed as in Fig. 157. The physician has great leverage in 
this movement. It stretches all the flexor group on the back 
of the thigh. 

The Calf Muscles. — The calf muscles sometimes con- 
tract and make it difficult for the patient to get the heel to the 
floor. Fig. 158 illustrates the method of applying leverage to 
the case. 




Fig. 158. — Method of stretching the deep and superficial muscles on the 
back of the leg. 

Scientific Manipulation. — Every group of muscles in 
the body can be relaxed by stretching them, hence if the student 
will study their attachments and the effects of their normal 
contraction, a series of movements can be devised to suit the 
condition. Learn anatomy in a practical manner and a system 
of osteopathic movements will spring forth from the under- 
standing mind of the student. The author has tried the plan 
of not demonstrating movements to students, but putting the 
whole attention to understanding the conditions in the patient 
which require treatment. A study of the mechanical difficulties 
presented and the comparison of these with the normal relations 
leads the student to apply anatomical knowledge in treatment. 
If the student .understands the case, that is, realizes the signifi- 
cance of the points found by the physical diagnosis ,he can be 
depended upon to apply a rational method of treatment. As 



PRINCIPLES OF OSTEOPATHY. 



345 



soon as the student makes a movement in a certain manner in 
order to copy his instructor instead of basing it on his own 
understanding of the condition treated, he degenerates to mere 
empirical methods. 

Saphenous Opening. — The circulation in the lower ex- 
tremity is frequently affected on the venous side by tension at 
the saphenous opening. Enlargement of the superficial veins 
of the leg above a point three or four inches above the ankle 




Fig- I 59- — Position for easy manipulation of the saphenous opening. 



denotes obstruction to free blood flow in the long saphenous 
vein. Abduction and extension of the thigh will stretch the 
fascia forming the saphenous opening, then place the thigh 
in a semi-flexed position, as in Fig. 159, to facilitate direct 
manipulation of the tissues forming this opening. The deep 
and superfical veins of the leg have little or no communication 
above a point about the junction of the lower and middle third 
of the leg. This applies especially to the long saphenous vein. 
Varicose veins on the feet or ankles may be drained by both 
superficial and deep veins, therefore, their existence in these 



346 



PRINCIPLES OF OSTEOPATHY. 




Fig. 1 60. — Position for easy manipulation of the popliteal space. 

locations may be due to visceral causes, even when there is no 
obstruction to the saphenous opening. 

Popliteal Space. — The popliteal space sometimes needs 
relaxation. This is performed by direct manipulation as illus- 
trated in Fig. 160. The position of the physician's hands in 
this illustration affect the upper portion of the popliteal space. 
By facing the patient the lower portion can be easily affected. 



CHAPTER XVIII. 



MANIPULATION FOR VASO-MOTOR NERVE 

EFFECTS. 

There are times when the physician desires to affect the 
amount of blood in the tissues of the head. There may be a 
congestion of the nasal, pharyngeal and laryngeal mucosa as 
during a hard "cold." The condition has come on as a result of 
thermal stimuli. After manipulating to relax the muscles of 



PRINCIPLES OF OSTEOPATHY. 



347 



the neck and overcome any effects these may have had on the 
position of the cervical vertebrae, it is well to try to cause vaso- 
constrictor action by stimulating nerve endings. Fig. 161 illus- 
trates a method of stimulating deeply under the zygoma in the 
sigmoid notch of the inferior maxillary bone. When the pa- 
tient opens his mouth, the physician places his finger over the 




Fig. 



161. — Stimulation between the zygoma and the sigmoid notch of the 
inferior maxilla. 



depression below the zygoma and presses inward, at the same 
time, making a vibratory movement of the finger. This affects 
the branches of Meckel's Ganglion and through it the nasal 
mucosa. It is a painful treatment, but the blood will often 
surge from the mucous tissues to the skin as a result of it. 

About the same effect is secured by using the movement 
illustrated in Fig. 162. While the patient's mouth is open, the 
physician places his thumbs on the bridge of the nose, and his 



348 



PRINCIPLES OF OSTEOPATHY. 




Fig. 162. — Stimulation by forcible closure of the mouth against resistance. 



fingers at the angles of the jaw. The tips of the little and ring 
fingers are pressed into the depression caused by the forward 
movement of the condyle of the jaw on the eminentia articu- 
lar is. The physician forces the mouth shut while the patient 
opposes. The position of the tips of the little and ring fingers 
prevents the easy slipping of the condyles into the glendoid 
fossa. The sensory fibres around the condyle are intensely 
stimulated and frequently manifest it by spreading a flood of 
color over the face in front of the ear. This is also a painful 
stimulation. It is highly probable that all movements of this 
character which are painful secure results by causing activity 
of the dilator nerves to blood vessels in superficial tissues, thus 
depleting the blood in the congested area. A sharp pain may 
cause a sudden blanching, but it is followed by vaso-dilation. 



PRINCIPLES OF OSTEOPATHY. 



349 



If it is difficult for the patient to breathe through the nos- 
trils, press on the nasal bones, first on the right side, then left, 
then make a heavy pressure over the junction of the nasal and 
frontal bone with one thumb above the other. This movement 
is very pleasant to the patient ordinarily. 

To carrv off the venous blood, make a stroke from the 




Fig. 163 — Points of exit of divisions of the fifth cranial nerve. 



inner canthus of the eye downward over the junction of the 
masseter muscle with the lower jaw, thence to the supra- 
clavicular fossae. 

The Fifth Cranial Nerve. — The fifth cranial nerve can 
be treated at its points of exit through the bones of the face. 
Fig. 163 illustrates the position of these points. A vibratory 
pressure over these points causes a dull but increasing pain. 



35o 



PRINCIPLES OF OSTEOPATHY. 



If the movement is made quickly and vigorously, there will be 
evidence of a reaction in a flushed appearance. 

Inhibition of Suboccipital. — When there is a high blood 
pressure in the head and the patient is suffering with headache 
it is possible to give great relief by steadily inhibiting in the 
suboccipital fossae and temples, as illustrated by Fig. 164. 
All nervous conditions are greatly reduced by this movement. 




Fig. 164- — Inhibition in the suboccipital fossae. 



The inhibition reduces the number of sensory impressions, and 
lessens the tension of blood vessels all over the body. This 
inhibitory movement should be used in cases of epilepsy and 
delirium tremens during the excitable stages. Have an assist- 
ant inhibit in the splanchnic area, thus causing a general re- 
duction of blood pressure in the superficial and deep tissues of 
the body and extremities. The blood is thus drawn away from 
the head, and the patient becomes quiet. 

To inhibit the transmission of impulses to the diaphragm 



PRINCIPLES OF OSTEOPATHY. 



35i 




Fig. 165. — Inhibition of the phrenic nerves — center for hiccough. 



by the phrenic nerves pressure should be made as in Fig. 165. 
The physician's fingers compress the phrenic nerve against the 
scalenus anticus. 

The phrenic, pudic and pneumogastric are the only nerve 



352 



PRINCIPLES OF OSTEOPATHY. 




Fig. 1 66. — Stimulation of the pneumogastric nerves. 



trunks distributed in the body which can be easily compressed 
through soft tissue. Fig. 166 illustrates stimulation of the 
pneumogastric. The physician's fingers roll over the nerve 
trunk where it lies along the inner edge of the sterno-cleido- 
mastoid. 



INDEX. 



Page. 

Accommodation 34, 233 

Acceleration of the heart. . 

77, 120, 198, 238 

Attribute of nerve tissue 239 

Abdomen, Examination of 260 

Alignment 250 

Angina pectoris 78, 195 

Anatomy 136 

Anaesthetic, Inibition as a local... 246 

Annulus of Vieussens 121 

Ankle, The 136 

Articulation, Occipito Atlantal. .146 

Sacro-iliac 148, 171 

Dorso-lumbar 163 

Costo-transverse 166 

Costo-central 166 

Sacro-vertebral 177 

Arteries — , 

Vertebral 121 

Internal Mammary 121 

Inferior Thyroid .,?. . . 121 

Nervi Comes Phrenici 121 

Descending Aorta 122 

Astringents 107 

Atrophy, Secretory cells 113 

Atlas 146, 154 

Axis 154 



B 

Blood 68 

Corpuscles, Red 69 

Corpuscles, White 69 

Chemical constituents of 71 

Distribution of 71 

Supply 107 

Back, Skin of 89 

Bladder center 218, 220 

Brain, Vaso-motor center 88, 92 

Brachial Plexus 187 



C 

Page. 

Cause and Effect 30 

Capillary circulation 86 

Cathartics 107 

Carotid plexus 119 

Cardiac plexus 128 

Caries 155 

Cauda equina 218 

Cell, Attributes of the 36 

Arrangement in glands 104 

Individuality of the 105 

Life dependent on circulation. . .31 

Resistance 3° 

Relations 30 

Stimuli 29 

Sexual 104 

Centers, Vaso-motor 88 

Abdominal viscera 132 

Cilio-spinal 123 

Hyperemia of 11 1 

Centers, Osteopathic 179 

Bladder 218, 220 

Chills 212 

Cilio-spinal 195 

Defecation 218 

Gall Bladder 213 

Heart 79, 195 

Kidneys 217 

Intestines 208, 215 

Liver and Spleen 207 

Lung 194 

Micturition 218 

Ovaries and Testes 217 

Parturition 218 

Rectum 218 

Sphincter Vaginas 221 

Stomach 200 

Cervical Plexus 184 

Cervical Vertebras 156 

Extension 321 

Region 318 



INDEX 



Page 

Cilio-spinal center 123, 195 

Circulatory Tissue 67 

Functions • • ■ „ 67 

Apparatus 72 

Chills 212 

Cholelithiasis 214 

Chorda Tympani 109 

Clavicles 171, 318 

Compensation 34, 112, 233 

Constipation 31, 113 

Contraction, Effects of muscular 

48, 238 

of the heart 74 

Conductivity 53 

Contraction, Muscular 158 

Co-ordination 166 

of sensation 65 

of heart centers 75 

of circulation 71 

Coronary arteries .' 78 

Costo-central Articulation 166 

transverse 166 

Costal Subluxations 167 

Cure, Methods of 34 

Curvature, Lateral 289 

D 
Definitions of Osteopathy. 

By E. R. Booth, Ph.D., D.0 22 

By C. M. Case, M.D., D.0 21 

By Charles Hazzard. Ph.B., D.O... 21 

By J. W. Hofsess, D.O 23 

By J. Martin Littlejohn, LL.D., 

M.D., D.O 21 

By Mason W. Pressly, LL.D., 

M.D., D.O 20 

By Chas. C. Reid, D.O. . : 24 

By Wilfred L. Riggs, D.O 24 

By A. T. Still, M.D, D.O 20 

By C. M. Turner Hulett, D.O.... 23 

By Chas. C. Teall, D.O 22 

By Dain L. Tasker, D.O 24 

By C. W. Young, D.O 23 

Development of bones. Unequal.. 154 
Defecation, Center 218 



Page 

Diaphoretics 107 

Diagnosis, Osteopathic 

24, 59, 61, 65, 180, 243 

Hilton's Law 139 

Diarrhoea 31, 113, 236 

Diffusion 105 

Diphtheria 44, 229 

Disease, Cause of 19, 29, 33 

Germ Theory of 223 

Dislocations, Atlas 147 

Reduction of 336 

of the Femur 341 

Diuretics 107 

Dorsal Vertebrae 157 

Rotation 289 

Dorso-lumbar Articulation 163 

Drugs 107, 1 13 



Efferent nerve fibers 60 

Emmenagogues 107 

Energy, Potential and Kenetic. . . .29 

Encysting, The power of 237 

Epkhelium 100 

Erector Spinas 274 

Errhines 107 

Examination, Of Abdomen 260 

Of the Neck 263 

Positions for 250 

Of Rectum and Prostate Gland.263 

Expectorants 107 

Extension in the Cervical Re- 
gion 321 

External Generative Organs, 

Vaso-motor Center 88 

Extremities, The 235, 265, 330 

Eye, Nutrition of 119, 153 

Vaso-motor Center 88 



Fascia 34 

Fatigue 34 

Fear 113 

Femur, Dislocation of 34 1 

Fever 112 



INDEX 



Page 

Filtration 105 

Flexibility 250 

Thoracic 260 

Food. Secretion 108 

G 

Gall Bladder 132 

Bladder, Center 213 

Ganglia, Cervical 1 18 

Gasserian 123 

Impar 115 

Lateral 115 

Lumbar 126 

Ribes 115, 119 

Sacral 127 

Semilunar 131 

Thoracic 122 

Visceral, Automatic 115, 134 

Germ Theory of Disease 223 

Gland, Arrangement of Cells.... 104 

Formation 103 

Gums, Vasomotor Center 88 

H 

Head, Vaso-motor Center 88 

Head's Law 142 

Headache 119 

Heart 72, 74 

Accelerator center yy, 120 

Action of heart centers 79 

Center 195, 75, 198 

Compensation 237 

Coronary arteries 78 

Effect of vaso-motor nerves. ..in 

Inhibition of the heart 78, 120 

Pneumogastric nerve 75 

Regulation of contraction 74 

Reflexly affected 215 

Stimulation of the yy 

Heat 113 

Hemiparesis 289 

Hemiplegia 96 

Heridity 31 

Herpes zoster 141 

Hiccough 186 

Hilton's Law 135, 181, 241 



Page 

Human body, Conception of 245 

.Hyperaemia 90, in 

Hyperesthesia, Diagnostic value 

of 258 

Of sensory areas 243 

Hyperplasia 93 

Hypogastric Plexus 133 

Hyo-glossus muscle 324 

Hyoid bone 323 

I 

Inco-ordination 167 

Inferior Cervical Ganglion 120 

Inflammation 102 

Inhibition 31, 238 

As attribute of nerve tissue, . . .239 

In Sub-occipital Fossae 350 

Osteopathic Meaning of 246 

Of Intestinal Secretion 113 

Of the Heart 78 

Of Vaso-constriction 96 

Pneumogastric nerve y6, 120 

Results of 244 

Therapeutic 241 

Immunity 225 

Innominate Bones, Luxation of 

171, 312 

Inspection 251 

Internal Generative Organs 89 

Interscapular Region 

112, 123, 130, 192 

Intestines, Center 132 

Large 208 

Small 209, 215 

Vaso-motor Center 88 

Irritability 52 

Ischsemia 90 

J 

Joints, Formation of 146 



K 

Katabolism 102 

Kidneys, Compensation 236 

Vaso-motor Center ....89, 126. 217 
Knee, The n6 



INDEX 



Page 

Kyphosis, Lower dorsal 164 

Upper dorsal 282 

Lumbar 164, 218, 285 

Treatment of 275, 299 

L 

La Grippe 113 

Language of pain 213 

Larynx, Intrinsic muscles of ....326 

Lateral curvature 289 

Subluxations 158, 162, 291 

Latissimus dorsi 268 

Law, Hilton's 135 

Head's 142 

Lesions, Effect of 44. 49 

False 157 

History of 265 

Primary and secondary ... .42, 145 

Remove 245, 248 

Leukemia 204 

Life, Conditions which affect it. .225 

Liver, Vaso-motor center 

89, 132, 207 

Locomotor ataxia 63 

Lordosis, Upper dorsal 278 

Lumbar Region 3 1 

Ganglia '. . 126 

Kyphosis 164 

Plexus 220 

Lung Center 88, 194 

Lymph 67 

M 

Manipulation no, 266, 344 

Massage no 

Metabolism ' 100 

Micturition, Center 218 

Middle Cervical ganglion 120 

Movements, Passive vs. Rest ....249 

Mucus 104 

Muscular contraction 158 

Tension, Test 259 

Muscle, Circulation in 48 

Contraction of 45, 238 

Development of 101 



Page 

Nerve distribution to 137 

Stimuli of 43 

Vaso-motor center 89 

Muscles, Adductors of the thigh. .341 

Deltoid 140 

Erector spina? 274 

Hyo-glossus 324 

Latissimus dorsi 268 

Mylo-hyoid 324 

Of the Back, Extrinsic and in- 
trinsic 254 

Of the Larynx, Intrinsic 326 

Of the Leg 344 

Pectoralis Major 272 

Quadratus Lumborum 273 

Quadriceps Extensor 340 

Recti Laterales 146 

Rectus Capitis Anticus Minor.. 152 

Rhomboids 271 

Scaleni 320 

Serratus Magnus 272 

Splenius Capitis et Colli .... 

187, 282, 321 

Sterno-cleido-mastoid 320 

Sterno-thyroid 325 

Sterno-hyoid 325 

Trapezius 187, 269, 319 

N. 

Neck, Examination of 263 

Nerve tissue 49, 51 

Acceleration and inhibition. .. .239 

Central nervous system . 56 

Conductivity 53 

CoutiOl 107 

Double conduction 55 

Efferent fibers 60 

Irritability 60 

Mechanical stimulation of 54 

Nerve bundles 55 

Reflex action 58 

Secretory nerves 106, 109 

Sensory 84 

Sympathetic ganglia 61 

Trophicity 53 



INDEX 



Page 
Unity of 54, 114 

Nerves. Circumflex 140 

Fifth cranial 349 

Fifth intercostal 141 

First four cervical 180 

Hypoglossal 183 

Of Wrisberg 191 

Phrenic 186 

Pudic 221 

Sciatic 343 

Spinal accessory 182, 196 

Nervous system, Cerebro-spinal.. 114 

System, Sympathetic 114 

Communicating fibers 115 

Gray rami-communicantes 117 

White rami-communicantes. ... 116 

Independence of 114, 118 

Lateral Ganglia 115 

Prevertebral Plexuses 115 

Origin 115 

Visceral ganglia 115 

Neuralgia, Cervico-brachial 189 

Neuritis 93 



Occipito-atlantal articulation 146 

Osmosis 105 

Osteopathic centers 178 

Osteopathy, Definition 19 

Diagnosis 24, 41 

Founder of 18 

Formation of name 26 

Growth of 18 

Its scope 26 

Mechanical principles 40 

Therapeutics 25 

View of pathology 213 

Ovaries, Center 217 



Page 

Paraplegia 218 

Parturition center 218 

Passive movements vs. rest 249 

Pathology 90, no, 153, 213, 242 

Pectoralis major 272 

Pelvic viscera 233 

Perspiration 109, 1 12, 236 

Phrenic nerve 286 

Physiology 106 

Pia mater 119 

Pilocarpin 107 

Plexuses, Brachial 115 

Cardio Pulmonary ...115, 122, 128 

Carotid 119 

Cervical 184 

Hypogastric 133 

Lumbar 220 

Pelvic 115, 133 

Pharyngeal 115 

Prevertebral 115 

Sacral 220 

Solar 115, 130 

Subsidiary 133 

Pneumogastric Nerve 

75, 132, 181, 198 

Poison 107 

Popliteal Space 346 

Portal System, Vaso-motor 

Nerves 89 

Pott's Disease 234, 299 

Power of Encysting 237 

Predisposition 31 

Primary Subluxations 162 

Principles, How to apply y 

Prostate Gland, Examination of. 263 

Pudic Nerve 221 

Pulmonary Plexus 129 



Pain 113 

Language of 213 

Palpation 25, 108 

Of the ribs 252 

Of the spine 253 



Quadratus Lumborum 273 



Rami Communicantes, White, 
Formation, Distribution 
and Function 116 



INDEX 



Page 

Gray, Formation, Distribution 

and Function 117 

Efferentes 122 

Rectum, Center 218 

Examination of 263 

Reflex Action 58, 60 

Intensity of 185 

Patellar Tendon 63 

Region, Interscapular 192 

Renal Center 126 

Resistance, Arterial 73 

Cell 30, 225 

Respiration, Nervous control of.. 167 

Pulmonary 113 

Rest 142, 249 

Rheumatism 98 

Rhomboids 271 

Ribs, Elevation or depression of. .261 

Eleventh and Twelfth 169 

Examination of 165, 262 

First 1 168 

Subluxation of 167, 303 

Tenth 169 

Rotation, Cervical 322 

Dorsal 289 

S 

Sacral Ganglia 127 

Plexus 223 

Saphenous Opening 245 

Scaleni 320 

Scapula, Subluxation of 191 

Sciatic nerve 136, 343 

Sebaceous glands .....' 107 

Secretion, Cutaneous 109, 1 12 

Digestive 113 

Inhibition of 239 

Renal 112 

Secretory tissue 100, 107 

Innervation of 109 

Segmentation of the Nervous 

System 56 

Semilunar ganglia 131 

Sensation, Conscious 144 



Page 

Sensory nerves .84 

Epithelium 102 

Serratus Magnus 272 

Sexual cells 104 

Sialagogues 107 

Skin, Compensation 236 

Solar plexus 131 

Specific causes of disease 224 

Treatment 228 

Sphincter vaginae 221 

Sphygmograms 215 

Spinal accessory nerve 182 186 

Spinal column, Curvature 234 

Palpation of 253 

Spine depressed 297 

Spinous processes. Approxima- 
tion of 161 

Separation of 160 

Splanchnic area 96 

Great 125, 131 

Lesser 125 

Least 125 

Spleen, Vaso-motor center 

89, 132 204, 207 

Splenitis Capitis et Colli. .. .282, 321 

Sterno-hyoid 325 

Sterno-thyroid muscle 325 

Stimuli, Direct and indirect 46 

Excessive 30, 31 

Normal 29, 1 1 1 

Of muscle 45 

Strength of 240 

Stimulation of the heart 77 

Structural defects 31, 107 

Structure vs. Function 245 

Stomach, Center 132, 200 

Hyperemia of 91 

Subluxations ....33. 35, 100, 108, 144 

Cause of 147 

Clavicles 318 

Costal 167 

Definition 145 

Diagnosis 145 

Lateral 158, 162, 291 

Primary and secondary. . .161, 162 



INDEX 



Page 

Reduction of 155, 291 

Ribs 303 

Suboccipital triangles 95, 184 

Fossa?, Inhibition in 350 

Superior cervical ganglion 

118, 152, 183 

Sympathetic Nervous System. .. .114 
Symptoms 31, 32, 61 

Subjective 265 



Tension, Test Muscular 259 

Testes, Center 217 

Therapeutics, Osteopathic 

25, 32, 94, no. III 

Hilton's Law 137 

Thoracic Ganglia 122 

Thorax, The 235 

Flexibility 260 

Throat, Vaso-motor Center 8P 

Thyroid Ganglion 120 

Gland 88 

Tissues, Structural and Contrac- 
tile 3* 37 

Circulatory 40 

Displacement by violence 4T 

Displacement by muscular 

contraction 43, 47 

Elastic 38 

Irritable 39, 49 

Metabolic 39, 100 

Tongue 88 

Tonics 107 

Tonsils 88 

Touch, The sense of 250 

Trapezius Muscle 269, 319 

Treatment of Abdominal Vis- 
cera 132 

Heart 130 

Rational 243 

Triangles, Suboccipital 184 

Trophicity 53 



Page 



U 



Upper Extremities, Vaso-motor 

Centers 89 

Uterus, Center 215, 218 



V 

Vaso-constriction 83, 84 

dilation 84 

Centers, Head, eyes, tonsils. 88, 187 

Centers, How they act 241 

Chief center 80 

Subsidiary centers 80 

Control of coronary arteries. . 

78, 199 

Nerves 79 

Nerves, Manipulation of 346 

Secretion 108 

Vertebrae, Atlas 95, 264 

Third Cervical 264 

Sixth Cervical. . . . 140, 156, 264, 329 

Seventh Cervical 140 

First Dorsal 112, 125 

Sixth Dorsal 132 

Seventh Dorsal 112, 125 

Eighth Dorsal 163 

Ninth Dorsal 163 

Tenth Dorsal 163 

Eleventh Dorsal 132, 163 

Twelfth Dorsal 126, 163 

Second Lumbar 218 

Viscera, Abdominal 132 

Pelvic 133 

Sensibility of 143 

Thoracic 130 

W 
Wrisberg, Nerve of 191 



260 





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